Proceedings of the National Workshop cum Seminar on ROLE OF YOGA IN PREVENTION AND MANAGEMENT OF...

Proceedings of the

National Workshop-cum-Seminar

on

ROLE OF YOGA IN

PREVENTION AND MANAGEMENT OF

DIABETES MELLITUS

1 & 2 March 2011

Organized by

Advanced Centre for Yoga Therapy, Education & Research, (ACYTER)

& Department of Physiology, JIPMER, Puducherry

in collaboration with

Morarji Desai National Institute of Yoga (MDNIY), New Delhi (An autonomous organisation under Department of AYUSH, Ministry of Health and Family

Welfare, Government of India, New Delhi)

Editor and Organizing Chairman:

Dr. MADANMOHAN Professor & Head, Department of Physiology & Programme Director, ACYTER

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),

(An Institute of National Importance under the Ministry of Health & Family Welfare, GOI)

Puducherry – 605006, India

CONTENTS

From the desk of the Organizing Chairman : Dr Madanmohan 1

Report on the workshop - cum - seminar: Dr Ananda Balayogi Bhavanani 2

Faculty of the workshop 11

List of participants 13

Academic programme 18

Committees 20

A yogic perspective on health and disease: Yogacharini Meenakshi Devi Bhavanani 22

Burden of diabetes and role of diet in its prevention and management: Dr Madanmohan 30

Health benefits of physical activity and yoga: Dr Ashok Kumar Das 34

Nature and nurture in diabetes: A geneticist’s perspective about the yogic approach: Dr

Srikumari Srisailapathy 38

How obesity leads to type II diabetes: A physiological explanation: Dr V Srinivasan 41

A review of research studies on yoga and diabetes: Dr BK Sahay 42

Beneficial effects of a yoga based lifestyle in improvement of risk factors for coronary

artery disease: Dr Shantaram Shetty 50

Yogic management of obesity: Dr Sharma VK 56

Improving agni and apana vayu in diabetics: Dr N Chandrasekaran 63

An innovative therapeutic approach towards diabetes: Dr Prakash C Malshe 65

Role of asana-pranayama in diabetes: Dr Manoj Naik 70

Yoga practices for prevention and management of diabetes: Dr Ananda Balayogi Bhavanani 77

Effect of yoga on oxidative stress and inflammation in type II diabetes: Dr Prabha

Adhikari and Dr Shreelaxmi V Hegde 95

Effect of yoga therapy on reaction time, biochemical parameters and wellness score of

peri and post menopausal diabetic patients: Dr Madanmohan et al 97

Teaching yoga to senior citizens: Smt Meena Ramanathan 99

Statistical method for medical / yoga research: Dr Lakshman Rao 103

Results of a survey of participant feed back at ACYTER: Dr Madanmohan et al 105

Introduction to ACYTER 110

Workshop photographs 120

FROM THE DESK OF THE ORGANIZING CHAIRMAN

At the outset, I wish to express my heartfelt thanks to the Secretary AYUSH, Ministry of

Health and Family Welfare, Govt. of India, New Delhi for giving me the opportunity and

honour to organize this national workshop-cum-seminar on “Role of Yoga in Prevention and

Management of Diabetes Mellitus”. Dr. Ishwar V Basavaraddi, Director, Morarji Desai

National Institute of Yoga (MDNIY), New Delhi motivated me to organize this national

workshop-cum-seminar. He and the staff of Morarji Desai National Institute of Yoga have

offered unconditional support to organize this workshop.

I am grateful for the encouragement and support of Professor KSVK Subba Rao, Director,

JIPMER who inaugurated the workshop and set the tone for its success. I thank Professor

Ashok Kumar Das, Medical Superintendent, JIPMER, whose active participation in the

workshop inspired the delegates. Professor S Badrinath, Project Coordinator and Professor KS

Reddy, Dean have been a source of support for organizing this workshop. I am grateful to the

distinguished faculty of the workshop who readily responded to my invitation at a very short

notice.

I thank my colleagues and friends from the Department of Physiology, ACYTER and other

departments of JIPMER who were of great help in organizing this workshop. Organizing

Secretary, Professor GK Pal made extra efforts to manage the scientific programme. Special

thanks are due to Yogacharya Dr Ananda Balayogi Bhavanani, Programme Coordinator,

ACYTER for coordinating the workshop and for compiling the proceedings. Thanks are due

to Dr. Zeena Sanjay, SRF, ACYTER for her help in compiling and proof reading the

proceedings.

It is a matter of great satisfaction that the workshop was conducted in a fitting manner and to

the satisfaction of delegates and the faculty. Lectures were of high quality and demonstrations

were educative and useful. The practice sessions were the highlight of the workshop and were

well received by the participants who expressed their satisfaction at being able to learn the

important practices in such a short time.

I am very happy to bring out the proceedings and hope that its contents will be useful to the

readers and motivate them to conduct similar seminars and workshops on therapeutic

applications of yoga leading to the integration of the science of yoga with modern medicine.

Dr. Madanmohan

[email protected]

1

Proc Ntl Workshop-cum-Seminar on Yoga & Diabetes

REPORT ON THE WORKSHOP-CUM-SEMINAR

The Advanced Centre for Yoga Therapy, Education and Research (ACYTER) and the

Department of Physiology, JIPMER organized a two day National Workshop-cum-Seminar

on “Role of Yoga in Prevention and Management of Diabetes Mellitus” on 1 & 2 March,

2011 at JIPMER. The workshop was organized in collaboration with Morarji Desai National

Institute of Yoga (MDNIY), New Delhi, an autonomous organization under the Department

of AYUSH, Ministry of Health and Family Welfare, Govt. of India. More than 200 medical,

paramedical and yoga professionals and yoga enthusiasts from all over the country

participated along with 100 medical students of JIPMER and 40 faculty, residents and staff

members of the Department of Physiology and ACYTER, JIPMER.

The workshop was inaugurated by Dr KSVK Subba Rao, Director JIPMER and Dr BK

Sahay, eminent diabetologist was the guest of honour. Senior faculty members from various

departments of JIPMER as well as eminent yoga and medical experts from all over the

country participated.

The workshop deliberated on the role of yoga in the prevention and management of diabetes

with keynote lecture, invited talks, lecture-demonstrations, panel discussions and practice

sessions that were given by a team of 30 resource persons from JIPMER; DIPAS; AIIMS;

Viniyoga Healing Foundation, Chennai; The Yoga Institute, Mumbai; Iyengar Yogashraya,

Pune; Antar Praksh Yoga Centre, Haridwar; KMC Mangalore; Vinayaka Mission’s Medical

College, Salem; Vivekananda Institute of Yoga Therapy, Karur; PGIBMS, Taramani,

Chennai and the International Centre for Yoga Education and Research, Pondicherry.

Faculty from JIPMER included Dr AK Das, Medical Superintendent, Dr Madanmohan,

Professor and Head, Department of Physiology and Programme Director ACYTER

(Organizing Chairman of the workshop) and Dr GK Pal, Professor, Department of

Physiology (Organizing Secretary of the workshop). Dr Zeena Sanjay, Sri E Jayasettiaseelon,

Sri G Dayanidy and Selvi L Vithiyalakshmi from ACYTER. Smt Lalitha Shanmugam, Smt

Devasena Bhavanani and Smt Meena Ramanathan from Yoganjali Natyalayam assisted in

the conduct of practice sessions under guidance of Dr Madanmohan and Dr Ananda Balayogi

Bhavanani (Coordinator of the workshop).

2


The first day of the workshop started with the inaugural function presided over by Dr KSVK

Subba Rao, Director JIPMER in the presence of Dr AK Das, Medical Superintendent and Dr

KS Reddy, Dean, JIPMER. The Guest of Honour for the inaugural ceremony was Dr BK

Sahay, former president of API and eminent diabetologist. After the traditional lighting of the

inaugural lamp and honoring of the dignitaries, the organizing chairman of the workshop, Dr

Madanmohan delivered the welcome address. In his welcome note he stressed on the

importance of yoga in modern medicine and also insisted to start practicing yoga regularly

from an early age.

Dr AK Das, Medical Superintendent, JIPMER then released a compilation of research studies

on yoga and diabetes for educational purposes that had been compiled by ACYTER. Dr AK

Das then addressed the gathering saying “Today we all are witnessing a tsunami of diabetes

mellitus”. He added that every 3rd

or 5th

person in India is diabetic and emphasized that our

focus should be on proper diet, lifestyle modification and attitude. “By yoga and lifestyle

modification we can over write the emphasis of genes and conquer this non communicable

disease”. Dr KS Reddy, Dean, JIPMER then released a booklet on Yoga and Diabetes in

Tamil that had been compiled by ACYTER. He said that diabetes mellitus is an important

non communicable disorder, a silent killer and India is fast becoming the diabetic capital of

the world with more than 5 crore diabetics. Diabetes affects most systems of the body and the

practice of yoga may delay the onset and progression of diabetes.

Dr BK Sahay, Guest of Honor released a booklet on Yoga and Hypertension in Tamil that

had been compiled by ACYTER following which he gave his special invited address. Yoga

is a science and it is part of the rich heritage of our culture. Diabetes appears even in the

younger age and we should start a war to reverse this trend. He said that we can and we

should concentrate with all our resources to prevent this massive epidemic of diabetes. He

outlined the main causes of diabetes such as genetic factors, stress, unhealthy lifestyle,

dietary habits as well as lack of physical activity. Promoting yoga across the country with

proper and judicious usage of its techniques can help treat and prevent diabetes.

Dr KSVK Subba Rao released the Proceedings of the “National Workshop-cum-Seminar on

Role of Yoga in Prevention and Management of Hypertension” that had been compiled from

the National Workshop organized by ACYTER at JIPMER in 2010. In his inaugural address,

3


he appreciated the excellent work being done by ACYTER at JIPMER under the dynamic

guidance of Dr Madanmohan and thanked Director MDNIY, New Delhi for initiating this

collaborative venture between MDNIY and JIPMER. Diabetes is affecting so many in our

country irrespective of gender, religion and economic status. He said that yoga has a major

role to play in controlling diabetes and should be practiced in daily life. More rigorous

scientific studies need to be done to validate its potential benefits and to make it more

acceptable to the scientific and medical community worldwide. The inaugural function ended

with a vote of thanks proposed by Dr GK Pal, Professor Dept of Physiology, JIPMER and

Organizing Secretary of the workshop.

The first scientific session of the day was chaired by Dr Vasudev Anand Rao, Professor and

Head, Department of Ophthalmology, JIPMER. The invited speakers in the session were Dr

BK Sahay, Dr AK Das and Dr Madanmohan. Dr BK Sahay’s presentation was on the “Role

of Yoga in Diabetes Mellitus’. He detailed the extensive studies carried out to assess effects

of yogic practices in treatment of patients of diabetes mellitus, hypertension, obesity,

bronchial asthma as well as in normal individuals at Vemana Yoga Research Institute,

Secundrabad. On the basis of their research studies, he suggested that dhanurasana,

ardhamatsyendrasana, halasana, vajrasana, bhujangasana, naukasana are most effective in

diabetes patients while yogamudrasana and shalabasana seem to worsen the condition. He

concluded that the practice of yoga improves metabolic control and insulin sensitivity and

also has beneficial effects on lipid metabolism. It helps control hypertension, improves

exercise tolerance and prevents long term complications of diabetes. Most patients report

improved subjective feeling of wellbeing and it is also useful in patients with secondary

failure to oral hypoglycemic agents.

The second invited talk of the day was by Dr AK Das who gave an illuminating presentation

of “Diabetes Mellitus as a Lifestyle Disease”. He explained about the history of diabetes

detailing the global nature of the disorder that has seen 171 million diabetic patients

worldwide with a prediction of the number becoming 366 million by 2030. He stressed that

the major impact of the disorder was found in South East Asia and the West Pacific. He

stated that diabetes is the 4th

leading cause of death globally and that 4 diabetics are detected

every minute across the globe. 20% of the world’s diabetic population is in India! He

4


suggested that yoga has a major role to play in tackling diabetes as it is cost effective,

feasible, not complex, and culturally acceptable. The importance of genetic factors and low

birth weight in the causation of diabetes as well as the occurrence at a younger age due to

lack of physical activity and obesity in children were highlighted by him. He concluded by

saying that the key to prevent diabetes mellitus was to maintain healthy body weight, take

healthy diet and exercise at least 30 min for 4-5 days/ week.

Dr Madanmohan, Programme Director ACYTER and Head, Department of Physiology gave

an enlightening talk on components of yogic diet and its importance in prevention and

management of diabetes. The healthy nature of fresh, holistic, nourishing satvik diet and the

hazards of a junk food based tamasic diet were highlighted.

The afternoon session started with a lecture-cum-demonstration by Dr N Chandrasekharan,

founder director of Viniyoga Healing Foundation, Chennai. The session was chaired by

Professor Srikumari Srisailapathy from Chennai. Dr Chandrasekaran detailed the

panchakosha concept and said that yoga therapy could be divided into 4 parts: sharirika

chikitsa, pranika chikitsa, indriya chikitsa and mano chikitsa. He said that the main principle

in yoga therapy is samanam working at primary level and shodhanam working at a higher

level. He detailed the different types of agni and prana while his colleague demonstrated the

variations of jataraparivratha that works on normalization of agni.

Dr Prakash C Malshe from Haridwar gave a lecture-cum-demonstration on “Yoga modalities

for the therapy and prevention of diabetes mellitus” and gave a three point outline of how

yoga can be effective in diabetes. These included measure to control obesity, measures to

control cholesterol and measures to improve beta cells function. He suggested that mithahara

with fasting helps induce secretion of hormone sensitive lipase (HSL) making it easier to

derive energy from the stored fat on the day of fast. He also suggested that inverted postures

help to release atrial natriuretic peptide (ANP) that is a stimulus for HSL. His hypothesis that

air filling maneuvers create a sense of satiety making it easier to tolerate hunger and that

suryanamaskar is designed to fill the digestive tract with air by using kaki mudra were

interesting. He also suggested that intermittent hypoxia produced by nishsheha rechaka

pranayama induces a state of hypoxia resulting in proliferation of stem cells and beta cells.

His suggestion to control peripheral neuropathy included persistent effortful contraction of

5


peripheral muscles in various asanas to promote maintenance and growth of neurons in

peripheral nerves.

The panel discussion that followed after tea was chaired by Dr PH Ananthanarayanan,

Professor and Head, Department of Biochemistry and coordinated by Dr Vijayalakshmi,

Professor of Physiology, JIPMER. The eminent panel members were Dr Shantharam Shetty,

Dr Prabha Adhikari, Dr G Himashree, Dr Srikumari, Dr V Anantharaman, Dr Vivek Kumar

Sharma and Dr S Velkumary. Dr Shantharam Shetty presented the details of the research

programme, “The Caring Heart Project” based on lifestyle management for reversal of

coronary artery disease that was conducted at the Yoga Institute, Santacruz, Mumbai in

collaboration with the Nair and Leelavati Hospital. It was a randomized control study that

showcased yoga’s ability to control sympathetic overdrive thus mimicking beta blockage

while producing lipid lowering and plaque stabilizing effects. Dr Praba Adhikari elaborated

on the effect of yoga on oxidative stress and inflammation in type 2 diabetes. Prof. CR

Srikumari Srisailapathy gave a presentation on “Nature and Nurture in Diabetes –a

Geneticist’s Perspective about the Yogic Approach”. She elaborated the types of nutritional

problems and genes implicated in diabetes and concluded that though our genes are our data

card, the adoption of a yogic lifestyle can produce change in gene expression. Dr G

Himashree’s talk focused on a physiological view of yoga and its potential in diabetes

mellitus. She emphasized that lifestyle modification need to be adopted from childhood itself

with emphasis on vegetarian diet coupled with regular physical activity, avoidance of

tobacco and alcohol along with reduction in mental stress through yoga. Dr V Anantharaman

stated that yoga is effective in increasing the motor and sensory nerve conduction in diabetes

along with a quicker relaxation of muscles. He said that yoga can improve the recovery

period, keep the mind calm and relieve pain. Dr Vivek Kumar Sharma’s short presentation

focused on research work done at JIPMER with regards to yoga and autonomic functions. Dr

S Velkumary gave a presentation on the role of yoga in prediabetes.

The afternoon session concluded with a practice session led by Dr Madanmohan, Dr Ananda

Balayogi, Dr R Murugesan, Sri G Dayanidy and Sri E Jayasettiaseelon focusing on yoga

techniques useful in prevention and management of diabetes. A team of yoga experts

6


including Smt Devasena Bhavanani, Smt Lalitha Shanmugam, Smt Meena Ramanathan, Dr

Zeena Sanjay, Selvi L Vithiyalakshmi, Dr Navasakthi and Dr Loganathan assisted.

On the evening of the first day, the delegates were treated to a spectacular cultural

programme that was a fusion of yogasana tableaux, Bharatanatyam compositions and

instrumental music that was presented by Yoganjali Natyalayam under the dynamic direction

of Kalaimamani Yogacharini Meenakshi Devi Bhavanani, Director of the institute. Dr

Ananda Balayogi actively coordinated the performance along with Smt Devasena Bhavanani.

The second day of workshop started with an early morning practice session led by the

ACYTER team that reviewed the techniques taught the previous day. The morning academic

session started with an excellent keynote talk by Yogacharini Meenakshi Devi Bhavanani,

Director ICYER at Ananda Ashram, Puducherry who stressed upon the importance of

developing proper yogic attitudes as a means to prevent and manage diabetes. The session

was chaired by Dr Santosh Kumar, Professor and Head, Department of Urology, JIPMER.

Ammaji, Meenakshi Devi Bhavanani is one of the world’s foremost authorities on yoga and

her talk was extremely beneficial for all participants as she gave many practical examples

from day-to-day life situations.

The panel discussion that followed was chaired by Dr AK Das, Medical Superintendent of

JIPMER and moderated by Dr GS Gaur, Addl Professor, Physiology, JIPMER. The panelists

were Dr V Srinivasan, Dr Mukta Wyawahare, Dr Varun Malhotra, Dr Vaishali and Dr Nalin

Mehta. Dr V Srinivasan highlighted the role of obesity in causation of diabetes and the role

of yoga in managing this risk factor. Dr Mukta Wyawahare presented a detailed exposition of

the medical perspective on diabetes and its medical management. Dr Varun Malhotra

described the beneficial role of yoga in diabetes and quoted from numerous studies that have

dealt with yoga and diabetes including his own work on nerve conduction and pulmonary

function in diabetes. Dr Vaishali gave a detailed comparison of exercise and yoga and their

benefits in patients of diabetes. Dr Nalin Mehta described the work at AIIMS through a

comprehensive yoga based intervention for lifestyle disorders including diabetes. This was

followed by a practice session led by Dr Madanmohan, Dr Ananda Balayogi Bhavanani, Dr

R Murugesan, Sri G Dayanidy and Sri E Jayasettiaseelon. They reviewed the various yoga

techniques taught to the participants on the previous day.

7


The post lunch session started with a stimulating lecture-demonstration by Dr Manoj Naik

representing the Iyengar Yogashraya, Mumbai. The importance of inverted postures in

normalizing blood glucose was elaborated with quality demonstrations of sarvangasana and

shirshasana. He also demonstrated other important asanas like dhanurasana, ardha-

matseyandrasana and pashchimottanasana. He was assisted by Sri Bidyadhar Kar who is an

Iyengar Yoga teacher based in Pondicherry. After his interactive session, Dr M Madhavan of

the Vivekananda Yoga Institute, Karur gave an informative lecture-demonstration

highlighting various techniques useful in prevention and management of diabetes. All

participants enjoyed the session and an active interaction with questions and answers

followed.

The tea break was followed by a group forum that discussed various aspects of the role of

yoga in prevention and management of diabetes. This was chaired by Dr IV Basavaraddi,

Director MDNIY and coordinated by Dr AK Das, the Medical Superintendent of JIPMER.

The panelists were Dr Nalin Mehta, Dr CR Srikumari Srisailapathy, Dr Varun Malhotra, Dr

V Srinivasan, Dr Madanmohan, Dr GK Pal, Dr G Himashree and Dr Prakash C Malshe. A

lively discussion about various therapeutic modalities of yoga useful in diabetes and the

probable mechanisms involved held the audience in rapt attention. It was concluded that an

integrated approach of yoga and modern medicine has great potential to restore the health

and well being of the diabetic patients. Suggestions were made to research various yoga

techniques individually and also bring out research studies, monographs and other scientific

compilations highlighting the therapeutic benefits of yoga.

Dr IV Basavaraddi, Director MDNIY was guest of honour for the valedictory function and

expressed his appreciation of work at ACYTER, JIPMER. In his special address he extolled

the medical community to research yoga in depth with proper adherence to the correct textual

basis and proper practice of yoga techniques so that the results were of international quality

and acceptable to the modern scientific community. Excellent feedback was received from all

participants who expressed their thanks to JIPMER and MDNIY for conducting such a

timely and useful workshop that is a need of the hour. The workshop declaration was read

out by Lt Col Dr Himashree and the gathering passed the declaration unanimously by a show

of hands. The vote of thanks was then delivered by Dr Ananda Balayogi Bhavanani who

8


expressed gratitude to Director JIPMER, Director MDNIY, invited resource persons and

participants of the workshop. He also thanked faculty, residents and staff of Department of

Physiology and ACYTER for their whole hearted efforts towards making the workshop such

a grand success. The workshop ended with the rendition of the National Anthem by all

participants.

DECLARATION OF THE WORKSHOP

National workshop-cum-seminar on “Role of Yoga in Prevention and Management of

Diabetes Mellitus”, attended by more than 200 delegates, comprising medical professionals

and students, yoga experts and discernible persons from the local town of Pondicherry, has

been a grand success. The physiological, pathological, psychological and metaphysical

perspectives of prevention and management of diabetes have been deliberated at length and

futuristic ideas and plans have also been put forth. We, the organizers, patrons, delegates and

all the participants, urge the State Government, Central Government, MCI & Department of

AYUSH to evolve a concrete policy for promotion of yoga as an adjunct to modern medicine

so that a mass movement for yoga awareness with a sound scientific footing can be initiated.

The workshop proposes the following recommendations with regard to the prevention and

management of diabetes mellitus through yoga:

1. The inculcation of yoga has to be not only at the medical level but at the school level

if we want to prevent diabetes. We need to concentrate our energies on working at the

school level itself and catch them young.

2. Screening for pre-diabetes needs to be intensified and yoga introduced to the pre-

diabetics to prevent them from going into full blown diabetes.

3. We need to bring out effective and consensus-based dietary guidelines keeping yogic

principles in mind.

4. A universal standardized yoga package needs to be evolved for diabetes so that the

diabetic patients all over the world can be benefited in a rational manner.

9


5. A universal standardized research protocol to scientifically evaluate the effect of yoga

on diabetes needs to be evolved with inputs from physicians, researchers and

statisticians.

6. Scientific evaluation and standardization of various recommended individual

techniques of yoga should be done and documented with publications so that the

benefits of the individual practices as well as their combination can be understood in

a scientific and rational manner.

10

FACULTY OF THE WORKSHOP

1 Dr. Prabha Adhikari, Professor,

Department of Medicine, KMC, Mangalore 14

Shri E Jaysettiyaseelon, SRF, ACYTER,

JIPMER, Pondicherry

2

Dr. PH Ananthanarayanan, Professor and

Head, Department of Biochemistry,

JIPMER, Pondicherry

15 Dr Loganathan, WHO Healthy Lifestyle

Project, JIPMER, Pondicherry

3

Dr. V Anantharaman, Former Professor,

Department of Physiology ,

Annamalai University and JIPMER

16

Dr Madanmohan, Professor and Head,

Department of Physiology and Programme

Director ACYTER, JIPMER, Pondicherry

4 Dr. IV Basavaraddi , Director,

MDNIY, New Delhi 17

Dr. M Madhavan , Director Vivekananda

Institute of Yoga Therapy, Karur, TN

5 Dr Ananda Balayogi Bhavanani, Programme

Coordinator, ACYTER, JIPMER, Pondicherry 18

Dr. Varun Malhotra, Professor, Department

of Physiology, SVMMC, Salem, TN

6 Smt Devasena Bhavanani, Senior Faculty,

ICYER & Yoganjali Natyalayam, Pondicherry 19

Dr. Prakash C Malshe, Consultant

Physician and Yoga expert, Haridwar

7

Yogacharini Smt Meenakshi Devi Bhavanani,

Director, Ananda Ashram at ICYER &

Yoganjali Natyalayam, Pondicherry

20

Dr. Nalin Mehta, Professor,

Department of Physiology, AIIMS,

New Delhi

8 Dr N Chandrasekaran , Director, Viniyoga

Healing Foundation of India, Chennai 21

Dr R Murugesan, Physical instructor,

JIPMER, Pondicherry

9 Dr AK Das, Medical Superintendent,

JIPMER, Pondicherry 22

Dr. Manoj Naik, Consultant Physician and

Yoga expert, Iyengar Yoga Institute, Pune

10 Shri G Dayanidy, Yoga instructor, ACYTER,


Dr Navashakthi, WHO Healthy Lifestyle

Project, JIPMER, Pondicherry

11

Dr TK Dutta, Professor and Head,

Department of Medicine,

JIPMER, Pondicherry

24

Dr GK Pal, Professor,

Dept of Physiology, JIPMER,

Pondicherry

12 Dr GS Gaur, Additional Professor,

Dept of Physiology, JIPMER, Pondicherry 25

Smt Meena Ramanathan, Co-ordinator,

CYTER, MGMC & RI, Pondicherry

13

Lt Col Dr G Himashree, Professor and Head,

Department of Physiology, ACMS and OSD,

DIPAS, Delhi

26 Dr. Sahay BK, Eminent Diabetologist and

Past President API , Hyderabad

11

27 Dr Zeena Sanjay, SRF, ACYTER,


Dr. CR Srikumari Srisailapathy, UGC

Research Scientist C, Department of

Genetics, PGIBMS, Taramani, Chennai

28 Shri C Shanmugam, Senior Faculty,

Yoganjali Natyalayam, Pondicherry 35

Smt Karpagam, Yoga Instructor,

Pondicherry

29 Smt Lalitha Shanmugam, Senior Faculty,

Yoganjali Natyalayam, Pondicherry 36

Dr. Vaishali, AP, Department of

Physiotherapy, KMC, Mangalore

30 Dr Vivek Kumar Sharma, AP, Dept of

Physiology, JIPMER, Pondicherry 37

Dr S Velkumary, AP, Dept of Physiology,

JIPMER, Pondicherry

31 Dr R Murugesan, Physical instructor,


Dr Vijayalakshmi, Professor, Dept of

Physiology, JIPMER, Pondicherry

32 Dr. Shantharam Shetty, Consultant Physician

and Yoga expert, The Yoga Institute, Mumbai 39

Miss L Vithiyalakshmi, Yoga instructor,

ACYTER, JIPMER, Pondicherry

33 Dr. V Srinivasan, Former Director-Professor

and HOD, Physiology, JIPMER, Pondicherry 40

Dr. Mukta Wyawahare, AP, Department of

Medicine, JIPMER, Pondicherry

12

LIST OF PARTICIPANTS

1 Abirami A,PG Student, MGMCRI,

Puducherry

2 Adhavan S, M.Sc.(Yoga) Student,

TNPESU, Chennai

3 Amar Arun Barawade,PG cum Tutor,

JNMC, Belgaum

4 Ambareesha K,Tutor in Physiology,

Kanchipuram

5 Anuradha N,AP, SSSMC&RI,

Kancheepuram

6 Arulmurugan N,Ph.D Scholar,

TNPE&SU, TN

7 Arumugam C,Deputy Chief Engineer,

NLC, Neyveli

8 Ashokkumar P,Ph.D student, TNPE&SU,

TN

9 Babu S,Ph.D Scholar, TNPESU, Chennai

10 Babu,M.Sc. Student, Annamalai

University

11 Balaji R, Intern, MGMC&RI, Puducherry

12 Balu K,PG Student, NMC, Nellore

13 Bharath T,PG Student, MSRMC,

Bangalore

14 Cathy Davis ,Student, ICYER,

Puducherry

15 Chandrasekaran K, Sports Officer,

Puducherry

16 Chiranjeevi Kumar C,Student, NMC,

Nellore

17 Deepthi TS,Student, NMC,Nellore

18 Dhanalakshmi B,MD Student

Homoeopathy, Puducherry

19 Dhanalakshmi Y,AP, IGMC&RI,

Puducherry

20 Eben Jeya Roy Y,Medical Records

Supervisor, JIPMER

21 Elumalai RYoga Teacher, Puducherry

22 Ganesh P,M.Sc., Student, Annamalai

University, Chidambaram

23 Gayathri V,Msc., Student, Kanchipuram

24 Geetha Jana,PG Student, MGMCRI,

Puducherry

25 Gowthami D,Yoga Instructor, Chennai

26 Hannah Gee-Clough,Student, ICYER,

Puducherry

27 Ilangovan S,Asst. Professor, WCSC,

Chennai

28 Jaisankar, Prof. of Skin Department,

JIPMER

29 Jayestri Kurushev,Ph.D Scholar,

MTPG&RIHS, Puducherry

30 John Preetham,Tutor, Dept. of

Physiology, NMC, Nellore

31 Kanchana N,PG Student, MGMCRI,

Puducherry

32 Kannan A,Ph.D Scholar, Puducherry

33 Karthikumar R,Ph.D Scholar, Puducherry

34 Kavitha U,Msc., Student, Kanchipuram

35 Kiran Kumar CH, Asst. Prof. of

Physiology, NMC, Nellore

13

36 Kowsalya V,Msc., Student, Kanchipuram

37 Lakshmi Jatiya, Professor, AVMC,

Puducherry

38 Mahalakshmy R,KMCPGS, Puducherry

39 Mahesh K Chillerge,Student, NMC,

Nellore

40 Manikandan A,M.Sc., Student,

Annamalai University, Chidambaram

41 Manish Kumar,AP, PIMS, Puducherry

42 Manisha Gaur,MBA student, Puducherry

43 Maria Fandeeva,Student, AYCM,

Puducherry

44 Mohanakrishnan J,Physiotherapist,

JIPMER

45 Monika Hruba,Student, ICYER,

Puducherry

46 Nagaraj S,Ph.D Scholar, Puducherry

47 Nalini YC,PG Student, KIMS, Bangalore

48 Napolean,M.Sc., Student, Annamali

University, Chidambaram

49 Nareshkumar S,MPT Student,

MTPGRIHS, Puducherry

50 Neelambikai N,Prof. of Physiology,

Coimbatore

51 Nilesh Netaji Kate,AP, MMC&HRI,

Kanchipuram

52 Niraimathi D,AP, IGMC&RI, Puducherry

53 Nirmala,M.Sc., Student, Annamalai

University

54 Nithyavikasini N,PG Student,

Coimbatore Medical College

55 Palanisamy H,Professor, AVMC,

Puducherry

56 Papa Dasari ,Prof. of OBG, JIPMER

57 Phillippa Henning,Student, ICYER,

Puducherry

58 Pooja Gaur,BDS Student, IGIDS,

Puducherry

59 Preetam B Mahajan,AP, IGMC&RI,

Puducherry

60 Prema M,Yoga Instructor, Cuddalore

61 Premkumari G,MPT Student,


62 Qairunnisa S,Tutor in Physiology,

Kanchipuram

63 Raja N,MPT Student, MTPGRIHS,

Puducherry

64 Rajalakshmi B,M.Sc. Yoga Student,

Annamalai University

65 Rajam R,Asst. Professor, WCSC,

Chennai

66 Rajyalakshmi S,Student, NMC, Nellore

67 Ram Mohan Singh Asst.Prof.,

Puducherry University

68 Ramadass L,MPT Student, MTPGRIHS,

Puducherry

69 Ramya K,PG Student, MGMCRI,

Puducherry

70 Rohini HN,Student, JNMC, Belgaum

71 Sahu SK,Asst. Prof., IGMIRI,

Puducherry

72 Sangeeta,Student, ICYER, Puducherry

14

73 Saravanakumar S,MPT Student,


74 Sashyalatha K,Professor, MGMC,

Puducherry

75 Sathish A,M.Phil Scholar, Puducherry

76 Sathyakumar D,M.Phil Scholar,

Puducherry

77 Savitha Y,Consultant Yoga Therapist,

Mangalore

78 Selvakumar,M.Sc., Student, Annamalai

University

79 Sendhil R,Ph.D Scholar, Puducherry

80 Senthil Kumar N,CMO, CYNH,

Villupuram

81 Shanmuga Sundaram,Yoga Master,

Villupuram

82 Shiv Mangal Yadav,Ph.D Scholar,

Puducherry

83 Shravya Keerthi G,Student, NMC,

Nellore

84 Siva,M.Sc. Student, Annamalai

University

85 Sivaraman G,Sports Officer, Puducherry

86 Sobana R,PG Student, MGMCRI,

Puducherry

87 Srinivasan TV, Professor, VMMCH,

Karaikal, Puducherry

88 Srinivasan,M.Sc., Student, Annamali

University

89 Sudhakar G,Student, NMC, Nellore

90 Sujatha V,MBBS Student, PIMS,

Puducherry

91 Supriya K Vinod,Ph.D student, RMVU,

Coimbatore

92 Suresh M, Tutor in Physiology,

Kanchipuram

93 Toora BD,Professor, AVMC, Puducherry

94 Udayakumaran KP,Professor, WCSC,

Chennai

95 Uma BV,Student, NMC, Nellore

96 Umadevi Kannan,M.Sc. Student, Chennai

97 Umamaheswari K,AP, IGMC&RI,

Puducherry

98 Varadharaju B,Student, NMC, Nellore

99 Vasantha Kumari K,Yoga Student,

Vijayawada

100 Vasuki R,Neyveli MVKM Trust, Neyveli

101 Velmurugan S,Mudaliarpet, Puducherry

102 Vengatesan P,Yoga Instructor,

Villupuram

103 Vijalakshmi G,Nurse, VCRC, Puducherry

104 Vijay,M.Sc., Student, Annamali

University

105 Yogesh MK,PG Student, MSRMC,

Bangalore

15

PARTICIPANTS FROM JIPMER AND INVITED GUESTS

1 Dr Ambarish Vijayaraghavan,

Asstt Prof, Dept of Physiology,

MSRMC, Bangalore

2 Shri Ambrosie Daniel,

Dept of Physiology, JIPMER

3 Dr Amudharaj D,

SR, Dept of Physiology, JIPMER

4 Dr Archana Gaur T,

JR, Dept of Physiology, JIPMER

5 Dr Ardhanari N,

Eminent Social Activist and Naturopath,

Puducherry

6 Shri Balasubramanian M,


7 Dr Basantha Manjari Naik,


8 Smt Bharathi Balakumar ,


9 Shri Dandapani SK


10 Dr Dinesh T


11 Shri Gopi K,


12 Dr Gopinath M


13 Dr Govindarajulu N,

Professor & Head, Physical Education and

Sports, Puducherry University

14 Dr Grishma B ,


15 Shri Harikrishna B, PhD scholar,


16 Dr Lalitha V,


17 Shri Mathivanan M,


18 Shri Mourthy S, ACYTER, JIPMER

19 Shri P Munisamy, ACYTER, JIPMER

20 Dr P Nalini, Former Professor, Pediatrics,

JIPMER

21 Shri Naga Syam Sundar Kiran, PhD

scholar, Dept of Physiology, JIPMER

22 Dr S Nishanth,


23 Padmapriya N,


24 Shri Paramakedou K, MRD (Retd),

JIPMER

25 Smt Patthu Ardhanari,

Nursing supervisor (Retd) Puducherry

26 Dr Pravati Pal, Professor,


28 Dr Punitha P ,


29 Dr M Rajajeykumar,


16

30 Shri Ramachandran D,


31 Shri Ramkumar, PhD scholar,


32 Dr Santhosh Kumar, Professor and Head

Dept of Urology and Medical Education,

JIPMER

33 Dr Saranya K,


34 Dr Sebanthi Dev,


35 Smt Sentamije Selvy,


36 Dr Senthil Kumar ,


37 Shri Subburaman K,


38 Smt Suseela S,


39 Smt Sutha M,


40 Smt Tamilarasi M, Dept of Physiology,

JIPMER

41 Dr Thenmozhi D,


42 Dr Vasudeva Anand Rao,

Prof & Head, Ophthalmology, JIPMER

43 Shri Vasudevarajulu, Former

Collector,Government of Pondicherry

17

ACADEMIC PROGRAMME

1 Mar 2011

8.00 – 9.00 AM: Registration & breakfast

9.30 – 10.00 AM: Inaugural function

9.30 – 11.00 AM: Introduction: Dr. Madanmohan

Keynote address: Dr. BK Sahay

Special talk: Dr. AK Das: Scientific perspective on DM

11.00 AM: Tea break

11.15 – 1.00 PM: Workshop-I

Gr 1: Dr Madanmohan, Gr 2: Dr Ananda,

Gr 3: Dr Murugesan, Gr 4: G Dayanidy

1.00 – 2.00 PM: Lunch

2.00 – 3.15 PM: Lecture Demonstration I by Dr. N Chandrasekaran

Lecture Demonstration II by Dr. Prakash Malshe

3.15 – 4.30 PM: Panel discussion I: Yoga Research in Diabetes Mellitus

Chairperson: Dr .PH Ananthanarayanan

Moderator: Dr Vijayalakshmi

Members: Dr. G Himashree, Dr. Prabha Adhikari, Dr. CR Srikumari

Srisailapathy, Dr. V Anantharaman, Dr. Shantharam Shetty, Dr. Vivek

Kumar Sharma and Dr. S Velkumary

4.30 PM: High Tea

5.00 PM: Workshop-II

Gr 1: Dr Madanmohan, Gr 2: Dr Ananda,

Gr 3: Dr Murugesan, Gr 4: G Dayanidy

6.30 PM: Cultural program by Yoganjali Natyalayam

8.00 PM: Dinner

18

2 Mar 2011

7.00 – 8.00 AM: Practice session

8.00 – 9.00 AM: Breakfast

9.00 – 9.30 AM: Yogacharini Meenakshi Devi Bhavanani: Spiritual perspective on DM

9.30 – 11.00 AM: Panel discussion II: Yoga therapy in Diabetes Mellitus

Chairperson: Dr AK Das

Moderator: Dr GS Gaur

Members: Dr. Nalin Mehta, Dr. V Srinivasan, Dr. Varun Malhotra, Dr.

Vaishali and Dr. Mukta Wyawahare

11.00 – 11.15 AM: Tea break

11.15 – 1.00 PM: Workshop-III

1.00 – 2.00 PM: Lunch

2.00 - 3.30 PM: Lecture demonstration III by Dr. M Madhavan

Lecture demonstration IV by Dr. Manoj Naik

3.30 – 4.45 PM: Open Forum

Chairperson: Dr IV Basavaraddi

Moderator: Dr AK Das

Members: Dr Madanmohan, Dr. Nalin Mehta, Dr. V Srinivasan, Dr. G

Himashree, Dr. Prabha Adhikari, Dr. CR Srikumari Srisailapathy, Dr.

V Anantharaman, Dr. Shantharam Shetty, Dr. Vivek Kumar Sharma

and Dr. Varun Malhotra

4.45 PM: Tea break

5.00 PM: Valedictory function

Workshop Faculty:

Group 1 Group 2 Group 3 Group 4

Dr Madanmohan Dr Ananda B Bhavanani Dr Murugesan Sri G Dayanidy

Smt Lalitha Shanmugam,

Sri Jayasettiaseelon

Smt Devasena Bhavanani,

Smt Meena Ramanathan

Dr Navasakthi,

Smt Karpagam

Miss Vithiyalakshmi,

Dr Zeena Sanjay

19

COMMITTEES

Chief Patrons:

Dr. KSVK Subba Rao Dr. IV Basavaraddi Director, JIPMER Director, MDNIY, New Delhi

Patrons: Dr. Ashok Kumar Das Dr. S Badrinath Dr. KS Reddy Med. Superintendent Project Co-ordinator Dean

Organizing Chairman: Dr. Madanmohan

Professor & Head, Dept. of Physiology and Programme Director, ACYTER

Organizing Sectretary: Dr. GK Pal

Prof. of Physiology

Treasurer Co-ordinator

Dr. GS Gaur Dr. Ananda Balayogi Bhavanani Adl Prof. of Physiology Programme Coordinator, ACYTER

Organizing Committee: Dr. P Vijayalakshmi Dr. Pravati Pal Dr. Vivek Kumar Sharma Dr. S Velkumary Prof. of Physiology, Prof. of Physiology, Asst Prof. of Physiology, Asst Prof. of Physiology,

Scientific Programme: Dr. GK Pal, Dr. D Amudharaj, Dr. S Nishanth, Dr. K Saranya, Dr. V Lalitha,

Mr. E. Jayasettiaseelon,

Practice Sessions: Dr. Madanmohan, Mr. G. Dayanidy, Miss. L. Vithiyalakshmi

Invitation: Dr. S Velkumary, Dr. Basanta, Dr. M Rajajeyakumar, Dr. Archana Gaur, Dr. P Punita,

Mr. B Hari Krishna, Mrs. M Tamilarasi, Miss. N Padmapriya, Mr. G. Dayanidy

Accommodation & Transport: Dr. GS Gaur, Dr. M Gopinath, Dr. T Dinesh, Mr. E Jayasettiaseelon,

Mr.V Kanagaraj, Mr. P Munisamy

Inaugural: Dr. Pravati Pal, Mrs. Bharati Balakumar, Dr. B Grishma, Mr. NSS Kiran, Mrs. P Sentamije Selvy,

Dr. Zeena Sanjay

Cultural Programme: Dr. Ananda Balayogi Bhavanani, Dr. S Nishanth

Food, Refreshment & Cleaning: Dr. Vivek Kumar Sharma, Mr. T Ramkumar, Mr. SK Dhandapani,

Mr. K Subburaman, Mrs. M Sutha, Mrs. S Suseela, Mr. C Sivakumar

Valedictory: Dr. D Thenmozhi, Mr. T Ramkumar, Dr. Zeena Sanjay

Accounts: Dr. GS Gaur, Mr. S Mourthy

Office Work: Mr. Mathivathanan

20

Workshop cum Seminar on Diabetes Mellitus: Work Distribution

Dr. Madanmohan : Organizing Chairman, Practice Session

Dr. GK Pal : Organizing Secretary, Scientific Programme

Dr. P Vijayalakshmi : Organizing Committee

Dr. GS Gaur : Treasurer, Accommodation & Transport,

Dr. Pravati Pal : Inaugural

Dr. Vivek Kumar Sharma : Refreshment

Dr. S Velkumary : Invitation

Mrs. Bharathi Balakumar : Inaugural

Dr. Basanta Manjari Naik : Invitation & Registration

Dr. M Rajajeyakumar : Invitation & Mementos

Dr. D Amudharaj : Scientific

Dr. D Thenmozhi : Valedictory

Dr. Archana Gaur : Invitation

Dr. S Nishanth : Scientific, Cultural

Dr. K Saranya : Scientific

Dr. P Punita : Invitation (registration and certificate)

Dr. T Dinesh : Accommodation & Transport

Dr. M Gopinath : Accommodation & Transport

Dr. V Lalitha : Scientific

Dr. B Grishma : Inaugural

Mr. T Ramkumar : Refreshment, Valedictory

Mr. B Hari Krishna : Invitation (Banners, Memento)

Mr. NSS Kiran : Inaugural

Mr. M Mathivathanan : Office work

Mrs. P Sentamije Selvy : Inaugural

Mrs. M Tamilarasi : Registration

Mrs. M Sutha : Refreshment

Miss. N Padmapriya : Registration & Certificate

Mr. SK Dhandapani : Refreshment

Mr. K Subburaman : Refreshment

Mrs. S Suseela : Refreshment & Cleaning

Mr. C Sivakumar : Refreshment & Cleaning

Mr. V Kanagaraj : Accommodation

Mr. Daniel : Inaugural

Mr. Gopi : Invitation distribution and Banner

ACYTER

Dr. Ananda Balayogi : Coordinator, Cultural Programme

Mr. E Jayasettiaseelon : Scientific, Accommodation and Transport

Dr. Zeena Sanjay : Inaugural, Valedictory

Mr. G Dayanidy : Practice Session, Invitation distribution

Miss. L Vithiyalakshmi : Practice Session

Mr. S Mourthy : Accounts

Mr. P Munisamy : Accommodation and Transport, Banners

21

Proc Ntl Workshop -cum- Seminar on Yoga & Diabetes

A YOGIC PERSPECTIVE ON HEALTH AND DISEASE

Kalaimamani, Yogacharini Smt. MEENAKSHI DEVI BHAVANANI1

"Health and happiness are your birthright! Claim them!" thundered the "Lion of modern

yoga" Yogamaharishi Dr. Swami Gitananda Giri Guru Maharaj. "You are born to be healthy

and happy. But, the goal of life is moksha – freedom!"

We live in "topsy-turvy times", when ancient values have been flipped onto their heads. One

rarely meets a truly "healthy" or "happy" person. In fact, for the vast majority of the human

race, health and happiness are distant dreams. Illness, depression, conflict, sorrow, stress,

tension and frustration are the "birthright" even of young children in modern times. Billions

of dollars are expended by the health industry. Medical science can put pig valves into

human hearts and transplant vital organs. Super specialty hospitals abound. The

pharmaceutical industry produces a huge amount of life-saving drugs. Why, then, is a truly

healthy, happy person such a rarity?

Modern man, like the Biblical Essau, has sold his birthright for a "mess of porridge". Like

Judas, he has betrayed his Christ consciousness, his cosmic consciousness, for less than "30

pieces of silver".

Swami Gitananda has put before us a simple reason for this sad state of affairs. He advised.

"If you want to be healthy, do healthy things. If you want to be happy, do happy things."

People cry, "I want to be healthy." Then, they indulge in bad habits like tobacco and alcohol,

spend late-hours watching television, do not exercise properly, do not drink enough water.

Others moan, "I want to be happy!" but they fight, they gossip, they quarrel, they criticize,

they delight in conflict, in violence, in defeating others, and crushing competition under their

feet. It is irrational to expect that by doing unhealthy things, one can be healthy. It is

irrational to believe that by doing unhappy things, one can be happy. Yes, man is an

irrational animal indeed!

Ashram Acharya and Director, ICYER and Yoganjali Natyalayam, Pondicherry. www.icyer.com

and www.rishiculture.org

22


Yoga is the ancient science of India which shows man not only how to claim his birthright of

health and happiness, but also to obtain the goal of life – moksha. Any scientist worth his salt

begins his career by studying the laws of nature and the basic theorems and tenets of his

science. The yogic scientist is no exception to this rule. The physicist studies the physical

laws of nature - gravity, momentum, etc. The chemist studies the chemical properties of

matter. The biologist studies life forms, the doctors, anatomy and physiology of the human

body. This is the "field" within which they will work, observing the laws of action and

reaction, the laws of cause-effect relationship, within that limited spectrum.

For the yogi, the entire universe and everything in it is his "field of research." He studies the

Universal laws which operate within this field. The law of karma, the law of cause-effect, is

an important Law for him. The yogi knows that the laws which govern the microcosm also

govern the macrocosm, and so, he understands that by studying himself, his "small self," his

"own self", his own body, mind and emotions, he can understand the "big self', the Atman,

Brahman. This process in yoga is called "swadhyaya" or "self study" and it is the fourth

niyama of Patanjali's Ashtanga Yoga. The rishis, cosmic scientists, have taught, "Without

moving out of one's own cave, one can comprehend the universe." They realized that

universal truths lay within one's very own heart. "Man, know Thyself" is the admonition

which was written on the entrance to the Greek temple at Delphi. This is the starting point of

all endeavors. This is the starting point in the long journey to claim one's birth right.

Alexander Pope, the great 18th century English poet, wrote, "Man, know thy self / presume

not god to scan / the proper study of mankind / is man."

Through this "self study" the yogi discovers that human nature is governed by an inexorable

law - and the very law which governs his nature - is the very law which governs the universe.

This law is called "Sanatana Dharma" or "the eternal law" and is unbreakable. One has no

choice but to discover it, and then, live in harmony with that eternal law. Only then will one

be entitled to enjoy one's birthright - health and happiness. The Christian Bible teaches, "The

wages of sin is death." "Sin" is nothing more than defiance, rebellion and disobedience to the

eternal law. Yogamaharishi Dr. Swami Gitananda Giri taught his students: "you cannot break

the law. You can only break yourself over the law." How do we know if we are "breaking the

law"? The results are there for all to see: sickness, suffering, unhappiness, conflict, stress,

and tension.

23


One might retort: "But I am unhealthy! I am unhappy! I am not breaking law! I am not an

outlaw!" Look again! Indeed, such a person must be breaking the law, whether knowingly or

unknowingly. Remember, even in human jurisprudence, "Ignorance of the law is no excuse."

No court on earth will excuse a law-breaker who pleads "ignorance of the law". All citizens

are expected to not only know the law, but also, to abide by it, so that the society may

flourish in a harmonious manner. But, who wants to be unhealthy? Who wants to be

unhappy? If these are the result of breaking natural law, then why do people do it? The

answer is pure and simple: ignorance. The Sanskrit word for "ignorance" is "avidya".

Patanjali, the sage who codified the principles of yoga 2500 years ago in 196 magnificently

concise sutras, calls "avidya" or "ignorance" as the "Mother klesha". A klesha is a hindrance,

an obstacle to spiritual growth. Basically, klesha is the root cause of all human problems.

There are pancha klesha or "five hindrances". Sometimes "klesha" is translated as "a knot of

the heart". It prevents the human being from further spiritual advancement and drags the

human into the mire of misery. The other four kleshas are: asmita (egoism), the sense of

separation, the sense of I, raga (attraction due to pleasure), dwesha (aversion due to pain) and

abinivesha (clinging to life, the survival instinct). These are the “obstacles” which stand

between man and his desire to claim his birthright of health and happiness. But the root of all

obstacles is avidya (ignorance), ignorance of the law, and hence, the constant attempt to

“break the law”.

What is ignorance? Look at the word. It is composed mostly of the word "ignore". "Ignore"

implies "a refusal to see". If we "ignore" someone, it implies a deliberate attempt to cut this

person out of the field of our awareness. If we attend a gathering and find someone we have

aversion towards (dwesha) present, we usually "ignore" that person, literally, turning "our

back on them" so that we do not have to "see" or "acknowledge” them.

But, if ignorance of the universal law causes us to break the law, and hence, results in disease

and unhappiness, why do we as humans continue on this path to death and destruction?

Because we are taught, and we willingly accept this falsehood, that we are not responsible for

our own health and happiness. We have given over the responsibility for our own health to

the doctor, and have asked him to find us a pill, or cut something out of our body, or stick

something into it, and make us healthy again. We have given the responsibility of our

happiness to the government, the society, to the media, to the entertainment industry, to anti-

24


depressant medicines, and asked them to "please us, to give us about we want, to make us

happy."

We have sold the most precious quality we possess as humans, "manas" or conscious

awareness, and its twin virtues, independence and self–initiative, to the various powerful

lobbies which govern our lives. And they in turn, most benevolently "put us to sleep", sedate

us, put us under anesthesia, so we no longer feel the pain inherent in breaking the law. We

are hypnotized into a fitful sleep from our childhood to our old age, and into the funeral pyre

itself. We are lulled into a somnolent state in order to make our life's journey bearable, with a

minimum of pain – we are neither healthy nor happy, but blissfully numb and anesthetized.

Why should our entire social, political, educational, business, commercial, media and

entertainment structure be geared to keeping us numb and dumb? For a simple reason:

there's plenty of money and power in unhappiness and disease. But, there's no money in

health and happiness. How would doctors and the huge drug industry support themselves if

all were healthy? Would we watch mindless violence and sex and vulgarity in cinemas and

television if we were truly happy? Would the manufacturers of weapons of mass destruction

flourish financially if all were happy and healthy? It is beneficial to all the world's

commercial interests that the five billion people on the planet are kept sick and unhappy, in a

state of unfulfilled desire and thus, in constant frustration.

As an example close to home, look at the field of dentistry. When I came to Pondicherry in

1968, there was one dentist in town. I did not know anyone who had problems with their

teeth. Cavities were rare. On the contrary, I was struck by the beautiful, white healthy teeth

of our Indian people. Even villagers had dazzling smiles! Life was simple. Processed foods

were a luxury. Natural food was the norm.

Cut to the present scenario. The number of dentists in Pondicherry numbers more than 500!

Children as young as four years of age have cavities and dental problems. I don't have to tell

you professionals where the problem lies. It is obvious! The abundance of refined foods,

sugars, sweets, soft drinks, ice creams, lack of oral hygiene has destroyed the nation's teeth!

The good old neem stick has been discarded as "old fashioned" and we now spend Rs.20 on a

toothbrush and Rs.50 on toothpaste which is not one-hundredth as effective as the old neem

twig! Is this progress? Is this the obedience to natural law? Is this health? The villager cannot

25


afford to buy toothbrush and toothpaste – this would cost him one day's wages. This

"progress" has not only taken his health, but also his happiness. He will “become unhappy

because he does not have the money to buy such items!” Should not the emphasis in social

dentistry be on spreading awareness of the horrendous damage caused to the teeth by these

modern junk foods and drink? But, emphasis seems to be more focused on cure, rather than

prevention. Lip service is given to these ideas but the powerful commercial lobbies are quick

to squelch any effective activism on these subjects. This is not only in the field of dentistry. It

is the fact in every single aspect of life. There is no money or glory or power in prevention,

but plenty of it in cure! Instead of educating people to "obey natural law", the modern trend

is to repair people who have "broken themselves over that law."

Avidya, ignorance! It is a disease, which is more deadly than an atomic bomb. It has already

burst upon the earth and is enveloping all mankind in its black, poisonous mushroom cloud.

It is the root cause of all unhappiness and disease.

"Vidya" – wisdom, knowledge – is the opposite of "avidya" or ignorance. It basically means

"to see". The rishis were "Men who saw Reality as It Is." If we wish to claim our birthright of

health and happiness, we must "Arise and Awake." We must open our eyes to see and our

ears to hear. When this "Awakening" occurs, one will be drawn to the yogic science. It is the

start of the long spiritual journey.

The "Core Concept" in accepting yoga as a way of life is embedded in the word

"responsibility". One must be prepared to accept "total responsibility" for one's own life, total

responsibility for one's thoughts, words and deeds, total responsibility for one's own health

and happiness. This is, in essence, obedience to the "eternal law" which states, "all karma –

all action – has its reaction and that re-action will always rebound on the one who committed

the action." Just as the sudarshan chakra (celestial discus) of Lord Vishnu followed the sage

Durvasa wherever he ran as he tried to hide until he made amends to King Ambarish for

harming him, so also the "reaction" of our "action" will follow us wherever we go, until we

"pay out" the karma in consciousness. In short, if we do unhappy things, we will be unhappy.

If we do unhealthy things, we will be unhealthy. There is no "breaking" this law and even the

best doctor, the best dentist or the best entertainer cannot keep our karma forever at bay. The

sign on the yogi's door (whether the door leads to his palace or the door leads to his cave)

26


reads. "The buck stops here." That is, the yogi takes total and complete responsibility for

himself and everything which happens to him and makes a conscious choice to "live within

the law", rather than choosing to be an "outlaw."

The word "responsibility" also has another aspect. Broken into two parts it reads "respond-

ability", or "the ability to respond". The yogic way of life cultivates and values consciousness

and awareness. Hence the yogi develops the "ability to respond" correctly to any given

situation. The correct "response" will produce a "positive effect" and the result of such a

positive action-choice is overall health, harmony and happiness.

Yoga is the science of consciousness, becoming aware of universal laws and obeying those

laws in thought, word and deed. Obedience to the law produces health and happiness.

Disobedience produces disease and suffering. As a scientist, the yogi employs all the tools of

any great science: he possesses an elaborate terminology which helps him define and

understand the problem; he possesses equipment and tools for his search – asanas,

pranayama, concentration practices, mantras, cleansing techniques, etc.

He/she enjoys access to a great body of theoretical concepts, accumulated through hundreds

of generations of "spiritual experiments" conducted by the great rishis who have preceded

him. This "theory" is recorded in the Vedas, the Upanishads, the Bhagavad Gita, the Yoga

Sutras, the Gheranda Samhita, the Hatha Yoga Pradipika and other ancient scriptures. His

laboratory, his field of research, is his own body, emotions and mind and his relationship and

correspondence to the Universe. The yogi is a detached observer who carefully records his

data and comes to his own conclusions based on his own direct observation and experiences.

He begins with this primary hypothesis – the universe is cosmos, it is not chaos. "Cosmos"

implies "order", and "order" implies "laws". He sets out to discover those laws and to observe

the working of those laws in his own life and in the lives of others. The yogi then attempts to

"apply" his findings in a practical manner – in his own life, coming to the same "realizations"

as those enjoyed by the rishis of old. Health and happiness manifest automatically in such a

life, which attunes itself to cosmic law. Health and happiness are automatic byproducts when

avidya or ignorance is dispelled and vidya, seeing reality for what it is develops. The yogi

follows the "great law of virtue" which is elaborated in the yogic tradition as the pancha

yamas or moral restraints and the pancha niyamas, the ethical observances. These maha

27


vratas, the mighty vows of virtue, reflect the Sanatana Dharma or the eternal law. The yogi

develops a love for virtue, a love for the law. He realizes "virtue is its own reward." He

attunes his own microcosm to the rhythm of the macrocosm. He moves with Nature, not

against it. Nature is his friend, with whom he lives in harmony, and not an enemy to be

conquered or exploited.

"Sanatana Dharma" is difficult to translate. It can be called "the eternal law", "the cosmic

law", even "the structure of the universe as it is". "Sanatana" means "eternal" – That which

was, which is, and which shall always be – unchanging, self-created, unborn, undying.

"dharma" takes its root meaning from "dhar" which means "stability, even-ness, balance."

The English word "durable" has come from "dhar" – that which endures. "Dharma" is hence

that which gives stability. Stability is an essential component of health. As any good doctor

knows, the best news he can give anxious relatives is that the patient has "stabilized."

Stability is also an essential component of happiness. Nothing creates more misery than an

unstable family, unstable romantic relationships, unstable work or social environments.

Sanatana Dharma sometimes is more loosely defined as "the law of virtue". Virtue creates

stability. Clean, pure, restrained, controlled, conscious aware living is the basis of all virtue.

Such qualities create personal, interpersonal and intrapersonal stability. Hence, one becomes

aware of the necessity of obeying "the law of virtue", if one wishes to be qualified to claim

one's birthright as health and happiness. As Yogamaharishi Dr. Swami Gitananda put it so

succinctly: “Following yama–niyama, obeying the cosmic law is "No-Option Yoga" for those

who wish to spiritually evolve themselves in health and happiness.”

Our ancients linked particular diseases to certain lapses in character. These linkages can be

found in many Puranas. Arthritis is linked to greed, refusal to let go, or to share. Digestive

problems were linked to hoarding, excessive, selfish accumulation. The old idea that diseases

were caused by a moral lapse had much truth. Interestingly enough, modern medicine is also

coming to a similar conclusion, though by a different route. Research findings have enabled

medical men to draw up "personality profiles" for cancer patients, heart attack patients,

diabetics, AIDS patients and so on. Character creates circumstances. Character is composed

mostly of the word "act". The manner in which we habitually "act" forms our "character."

Our actions determine whether we are healthy or unhealthy, happy or unhappy. This is the

28


essence of Sanatana Dharma. We create our own destiny by our thoughts, our words and our

actions. There is no such thing as an "innocent victim" in the universal Scheme of Things.

The yogi grows in consciousness and spirit till he becomes an "adhikarin" a "fit person" for

"realizing reality". He becomes competent to "claim his birthright of health and happiness."

But, that is only the beginning of his journey. He has arisen! He has been awakened! And

now it is his duty to "stop not till the goal of moksha" is reached. But, though the pilgrimage

is long and arduous, the universe herself/himself/itself grants him his birthright – health and

happiness as the reward for obeying natural law. He has the health, strength and good cheer

to make his cosmic journey and he has the happiness to enjoy his travels in space and

consciousness. Buoyed by this spiritual legacy, the yogi now has a raft to cross the ocean of

samskara. "Avidya" or ignorance of universal law is banished by "vidya", the light of

conscious awareness. His eyes are opened. He sees! Happily and healthily he realizes that he

lives not on a small planet, in a small galaxy, tiny as a grain of sand. He is a universal being,

a universal citizen obeying the laws of the cosmos. And the Universe is his own, his native

land!

29


BURDEN OF DIABETES AND ROLE OF DIET

IN ITS PREVENTION AND MANAGEMENT

Dr MADANMOHAN MD, DSc, FIAY 1

Non-communicable diseases including diabetes mellitus (DM) impose a huge burden on our

health care delivery system and are responsible for more than 60% morbidity and mortality.

They represent a “slow motion disaster” as their incidence and death toll is rising steadily.

Rapid urbanization, consumption of fast foods, sedentary life and stress are at the root of the

problem. India was projected to become the diabetic capital of the world. However, this

dubious distinction has been taken by China with 90 million diabetics as compared to India’s

61 million. It is projected that in 20 years, these figures will increase to 130 million and 100

million respectively. If we do not take preventive measures, the numbers will rise and India

many wrest the title of the diabetic capital of the world from China. Unless we take

appropriate measures, we are likely to surpass China in population, number of elderly,

obesity and chronic disorders including DM. While in the west, type 2 DM peaks in 60s, in

India, it is ~10y less. Furthermore, the average age is decreasing with large number of people

developing the disease in their 30s, the peak of working lives. This has a tremendous

economic impact on the individual, family and the nation. “Hidden” diabetes, characterized

by dysglycemia and impaired glucose tolerance occurs in about 20% of “healthy” people.

Many such persons remain undiagnosed till the disease reaches an advanced stage.

Childhood obesity is another cause of worry. As in west, 20% children from affluent Indian

families are obese and 8% have higher blood pressure. Junk food topped by colas and chips

as well as lack of physical activity due to excessive computer use is the cause of childhood

obesity. Gestational diabetes results in obese kids who have higher risk of developing type 2

DM.

Puducherry has a high prevalence of DM. A recent survey on the eve of World Diabetes Day

(14 Nov) has reported that 6% of population has the disease. Since the numbers are usually

underestimated, the actual prevalence is likely to be about 12%. The figures are 17% for

Professor and Head, Department of Physiology and Programme Director, ACYTER, JIPMER,

Pondicherry.

30


Mumbai and 40% for Nauru, a small island in the Pacific. A silent killer, DM is a cruel and

deadly disease that goes hand-in-hand with other chronic disorders. Diabetic neuropathy,

retinopathy, nephropathy and diabetic foot make the life of patient as well as care givers

miserable. Access to quality medical care is a dream, especially for our rural masses.

Prevention is better than cure. Being holistic, yogic lifestyle is ideal for prevention as well as

management of DM. The key elements of yogic lifestyle include yogic diet, disciplined yoga

practice, management of stress and development of yogic attitude. Education and awareness

are of fundamental importance. Early detection and lifestyle modification should be the

cornerstone of the strategy. Healthy lifestyle should be adopted early in life since major

biological and behavioral risk factors emerge early in life and continue to have a negative

impact throughout one’s life. Education and healthy meals in schools will go a long way in

stemming the tide of DM and other chronic disorders. Junk food, including colas should be

banned in schools. Such measures may be costly, but the returns are cost-effective with long-

term benefits.

DM results from an interaction between genetic and environmental factors. Genes determine

susceptibility to disease and opportunities for health while environmental factors determine

which susceptible person will develop the disease. Nutrients and physical activity influence

gene expression. Gene-nutrient interactions are modulated by the dynamic influences of

environment. Individual genetic variations influence the impact of change in diet. Since we

cannot change the genetic code of the population, we have to emphasize environmental

factors. A substantial increase in the incidence of DM in recent years clearly suggests

important role of environmental rather than genetic factors. It also suggests the potential of

stemming the tide by lifestyle modification. Significant increase in the incidence of type 2

DM has occurred in populations in which there have been major changes in the type of diet

consumed with the resultant increase in body weight and central obesity. Improving diet and

increasing physical activity in all age groups-young, adults as well as elderly, will reduce

chronic disease risks including that of DM. Diet and physical activity is a complementary

strategy not only for prevention, but also for retardation of progression of the existing

chronic disease. Healthy eating is the corner stone of prevention and management plan of

DM. Hence, patient should stick to diet schedule, including meal time and quantity.

31


Proper food is the most important factor in the promotion of health. Yogic diet is essentially

satvik diet. Yogeshwar Krishn describes satvik diet as one “that promotes longevity,

intelligence, vigor, health, happiness, cheerfulness and which is tasty, plain, substantial and

naturally agreeable (Bhagavadgita 17:8). From this it is clear that satvik diet must be

nutritionally balanced, fresh and pleasant to senses. Satvik food should be offered to the

Divine, shared with others and then taken as “prasad” in moderation as yogeshwar krishn

emphasizes the importance of proper diet (yuktahar, Bhagavadgita 6:17). Over eating and

untimely meals should be avoided. Satvik diet improves physical and mental health and

quality of life. It may help in reducing the drug dose and postponing complications of chronic

diseases. Some people misunderstand the meaning of satvik diet as one devoid of animal

flesh and onions-garlic and then take unhealthy, tamasik junk items made from white flour,

saturated fats, sugar and salt. In India, liberal intake of sweets, especially on festivals and

other celebrations, the ubiquitous samosa and all pervasive chips are examples of junk food

that contribute to obesity and dyslipidemia. Such energy-dense and low nutrient diet is at the

root of chronic diseases including DM. Dietary recommendation should be tailored to

local/national diets. 20-30 biologically district types of foods with emphasis on plant based

fresh items should be consumed in a week. Quantity of polished rice should be reduced and

whole grains and pulses included in the daily diet. Traditional Indian diet consisting of

rice/chapati, dal, curds and salad is an example of healthy diet. Taking of junk food clusters

together with low intake of healthy diet like fruits and vegetables. Taking a variety of fresh

fruits and vegetables and other plant-based items like whole grains and dals plays a key role

in supplying the nutrients and reducing the risk for chronic diseases including DM. The

consumption of fruits and vegetables is very low in India, especially in low income groups.

India’s average consumption of 120 gm/capita/day is much below the recommended intake

of 400 gm/capita/day. Mindless urbanization has resulted in more people getting away from

primary source of food production resulting in negative impact on availability of nutritious

and fresh food.

Normal adult needs ~30g fiber/day. Plant based satvik food based on whole grains and pulses

and adequate in vegetables and fruits supply enough fiber. The role of fiber in preventing

chronic diseases like DM, heart disease, colon cancer, hemorrhoids, diverticulitis and

constipation has been well recognized. Insoluble fiber speeds food through colon and

32


improves bowel health. Soluble fiber stabilizes blood sugar and lowers cholesterol. One

should eat a variety of fiber rich food items e.g. whole grains, millets, corn, oats, barley,

fruits and vegetables. To avoid bloating, take sufficient water and increase the quantity of

fiber gradually.

There are reports suggesting that moderate intake of alcohol (2-4 units/day) decreases the

incidence of deaths due to DM, CAD, other chronic disorders and text books also endorse

this opinion. However, alcohol cannot be recommended even in moderation because of its

health risks. Weight loss is a key factor in improving several markers of quality of life.

Alcohol consumption adds to the calories consumed. People cannot control their appetite for

alcohol and alcohol related deaths are also common. Advice/strategies should be culture and

gender sensitive and many Eastern cultures and women do not permit alcohol consumption.

Keeping these points in view, we cannot encourage people to “drink in moderation”. We

have safe and healthy ways of lifestyle modification-healthy diet, exercise and management

of stress.

33


HEALTH BENEFITS OF PHYSICAL ACTIVITY AND YOGA

Dr ASHOK KUMAR DAS, MD1

Healthy lifestyle is the foundation of good health, freedom from disease and improved

quality of life (QoL). Physical activity is an important component of healthy lifestyle.

Regular physical activity promotes health and fitness. Compared to those who are inactive,

physically active individuals have higher levels of cardio-respiratory fitness and stronger

muscles. When moderate intensity aerobic exercise is performed for 150 minutes per week

(i.e. 30 min / day, 5 days a week), benefits include lower risk of premature death, coronary

heart disease, hypertension, type 2 diabetes mellitus and depression. Health benefits continue

to increase proportionately and when the above activity is done up to 300 minutes per week,

additional benefits include lower risk of colon and breast cancer and prevention of unhealthy

weight gain. The benefits of physical activity include:

1. Reduced risk of cardiovascular disease.

2. Reduced risk of type 2 diabetes mellitus, metabolic syndrome, cancers including

colon, breast and endometrial carcinomas.

3. Strong bones and muscles.

4. Improved mental health and mood.

5. Improved ability to do daily activities.

6. Prevention of falls and injuries.

Physical activity in children:

According to physical activity guidelines, children and adolescents should exercise for at

least one hour per day (mostly aerobic) out of which at least 30 min per day, 3 times a week

should be muscle strengthening, stretching and bone strengthening exercises. However, only

two 30-40 minute periods per week are scheduled in most of the Indian schools. Also, there

is no structuring of exercises to include the above mentioned objectives of the physical

activity. Childhood obesity is already an epidemic. Hence, physical activity / exercise

programme in school curriculum needs due emphasis.

Senior Professor of Medicine and Medical Superintendent, JIPMER, Pondicherry

34


Physical activity in adults:

For health benefits, adults should do at least 150 min a week of moderate intensity or 75 min

a week of vigorous intensity aerobic physical activity or an equivalent combination of

moderate and vigorous intensity aerobic activity. Aerobic activity should be performed in

episodes of at least 10 min. Adults should also do muscle-strengthening activities that are

moderate or high intensity and involve all major muscle groups on 2 or more days a week.

Physical activity in older adults:

Apart from the guidelines for adults, balance training exercises should be included for older

subjects as they are susceptible to falls. If older adults find it difficult to do 150 minutes of

moderate intensity exercise per week because of chronic conditions, they should try to be

physically and mentally active as much as possible. They should not attempt to do any

activity which involves sudden jerky movements and intense effort.

Acrobic exercises that involve large muscle groups like walking, running and swimming also

have health – promoting and therapeutic effect. The intensity of the exercise should be

enough to produce 50-80% of maximum heart rate of the individual. Maximum heart rate is

calculated from the formula:

HRmax = 220 – (age x 0.5 - 0.8)

Exercise session should be for at least 30 min and on 4 or more days a week. Instead of 30

min on one day, one can have 3 sessions of 10 min each. Young men can do moderate or

vigorous exercise, 60 min a day for at least 3 days a week.

Advantages of yoga:

As compared to other physical activities, yoga can be more beneficial for older adults. Yoga

asanas should be performed within 80% capacity of comfortable zone. In modern life, older

population is suffering from stress due to changing socio-economic factors, nuclear families

and longer but less healthy life. And yoga is the best means to prevent as well as manage

stress.

Yoga as well as other forms of physical activity including moderate intensity aerobic

exercises are beneficial. However, yoga has many advantages. During physical exercises,

35


there is no breath-body co-ordination and they usually are high impact exercises thereby

increasing the risk of injury to joints, tendons and ligaments. Yogic exercises are low

impact, slow, rhythmic and sustained stretches which include alternate flexion and extension

movements of the joints involved. It needs to be emphasized that the holistic science of yoga

is the best lifestyle ever designed. Yoga is holistic as it has promotive, preventive as well as

curative potential. It is holistic because it improves our physical, mental as well as spiritual

health. Yoga is an ideal means to improve physiological functions and promote health and

fitness. The overall health benefits of yoga include healthy muscles and bones, flexible joints,

healthy weight with improved body mass index, improved concentration and memory and

reduced anxiety and depression with resultant improved quality of sleep. The improved

overall health is associated with a sense of wellbeing, better energy level and QoL. Yoga has

many advantages. It is an effective and inexpensive means to achieve holistic health. It is

target-oriented and easy to learn, teach and propagate. Yoga is an all-weather discipline that

has positive side benefits in contrast to negative side effects of drugs. Every one can and

should practice yoga whether child, youth, elderly, literate, illiterate, healthy or sick.

Apart from health-promoting effects, yoga has a wide ranging therapeutic benefits. It reduces

the risk of developing obesity, osteoporosis, high blood pressure and type 2 diabetes mellitus.

Yoga can reduce blood pressure in hypertensive patients, blood glucose in diabetics and

cholesterol in patients with coronary heart disease. In early stages of the disease, disciplined

practice of yoga along with yogic diet can result in complete cure. In more advanced stages,

the need for medication may be reduced, thereby reducing the economic burden and negative

side effects of drugs. Yoga is beneficial in type 2 diabetes mellitus as it improves insulin

sensitivity and decreases body fat and stress levels. Yoga reduces the risk of dying from heart

disease and stroke. Regular yoga practice along with standard medical treatment should be

encouraged to improve the overall health and QoL of the patient.

Yogic postures (asans), breathing techniques (pranayams) and relaxation (shavasan) have

great therapeutic potential especially when practiced in combination and with concentration

and awareness. According to Mahrishi Patanjali, asan should be steady, firm and comfortable

(Sthir-sukham-asanam. Yoga Darshan, 2:46). Going into the posture and coming out of the

posture should be done with slow, uniform and graceful movement while maintaining the

posture should be steady and without movement. Movement should be with awareness and

36


accompanied by correct breathing. By acquiring mastery of asan, the effort becomes relaxed

(“effortless effort”) and one can meditate on the “Endless” (Prayatna-shaithilya-anant-

samapattibhyam. Yoga Darshan, 2:47). One can also concentrate on any organ that needs

healing and direct one’s mental energy / pran shakti to that organ or part of the body. This

will improve the function of that organ and promote rejuvenation and healing.

Adham pranayam is diaphragmatic or abdominal breathing that is easy to perform and

effective in management of stress and type 2 diabetes mellitus. It is done in a comfortable,

straight back sitting position (sukh asan) or while lying on the back. While inhaling slowly,

uniformly and deeply through nose, one feels expansion of abdomen and while exhaling

through mouth, one feels abdomen falling back to the original position. Movement of chest

wall should be as minimum as possible. The movements of abdomen and chest wall can be

felt with two hands kept on abdomen and chest wall. Breathing should be deep, slow and

uniform and with concentrated awareness. Yoga is quite safe. However, a patient should

always consult his/her physician before starting the yoga practice. One should be extra

careful if there are pathological changes like retinopathy and nephropathy or if blood sugar is

very high (>250 mg/100 ml) or very low (<80 mg/100 ml).

37


NATURE AND NURTURE IN DIABETES: A GENETICIST’S

PERSPECTIVE ABOUT THE YOGIC APPROACH

Dr C R SRIKUMARI SRISAILAPATHY1PhD

It is a paradoxical fact that our human society is facing two nutritional problems. 600 million

people face severe energy deficits and starvation while at the same time 310 million people

face a problem of chronic energy surplus and obesity. Linked to obesity, the most worrying

trend is that diabetes is being diagnosed in younger and younger Indians. Central body

obesity is particularly important because of its association with diabetes, dyslipidemia,

hypertension and cardiovascular disease. ‘Asian Indian phenotype’ (that has greater

susceptibility to diabetes), refers to increased visceral fat and central body obesity, despite

low rates of obesity as defined by body mass index. Within the term “diabetes” geneticists

are discovering dozens of conditions/genotypes. The delineations are becoming fuzzy, owing

to the fact that the candidate genes support a shared etiology between type 1 and type 2

diabetes.

With the advance of genomics the list of candidate genes is ever growing. No wonder

consistent with the complex web of physiologic defects in diabetes, the genetics of the

disorder involves a large number of susceptibility genes – each with a relatively small effect.

The good news is, the analysis of the genetic factors is further complicated by the fact that

numerous environmental factors interact with genes to produce the disorder.

Geneticists now understand that one plus one is not equivalent to two and a new field of

genetics called epigenetics has emerged with the understanding of other dimensions. It is

indeed a combination of genes and certain genetic patterns. Being exposed to different

lifestyles, one ends up with different outcomes. As said by a nutrigenomics expert Dr.

Vincent Bellonzi, “Time after time, we see people who don’t care for themselves and create

disease. We see people that take care of themselves and create health. Ultimately our genes

are our data cards; one can play that, in any way one wants. Why is it that people with the

UGC Research Scientist C, Department of Genetics, PG Institute of Basic Medical Sciences,

Taramani Campus ,University of Madras, Chennai 600113, India. Email: [email protected]

38


same genetics look different, feel different and have different outcomes? Because of the way

the genes are treated”!

One has to start learning how to treat the genes. In other words it is about taking

responsibility for ourselves and the lifestyle we adopt. So, when we talk about genomics we

actually talk about treating a certain collection of genes in a certain way to get a certain

outcome. And if we learn more about genomics we have more and more control over the

outcome. This literally brings us to the fact that our activities, our eating habits and the yogic

lifestyle we adopt, produce a change in the gene expression. Though we cannot change our

genes, we have a lot of control over genetic expression in terms of our lifestyle.

It is here that the role of asanas (yogic postures) is to be understood. It adjusts the function of

organs involved, by regulating nervous impulses and blood flow to the glandular areas and

by gently massaging and improving the circulation in all the glands and organs. Pranayama

controls the body energy, allowing vital forces to flow to those areas that require extra

energy. And then come the mudras, bandhas apart from suryanamaskaras and relaxation

techniques like yoganidra (a rediscovery by Swami Satyananda from tantra) with scientific

documentation of its efficacy by recording biofeedback like EEG patterns and other

electrophysiological changes.

Above all the yogic attitude to life can influence the very important section of the brain

called hypothalamus that exercises control over major internal organs. It is considered to be

part of the major functional link between mind and body. Yoga essentially increases the

awareness of the needs and capacity, promoting digestion and metabolism and offering the

rewards on health, vitality and higher consciousness. In the process, brain, pancreas and other

organs get revitalized consciously and systematically. Yoga is an experiential science which

cannot be understood intellectually and will become only living knowledge through practice

and experience. Brain function itself is determined through complex and plastic gene

expression pattern. Genes - brain – behavior/lifestyle paradigm is the fundamental concept

that describes an individual’s response to the environment including social environment. Not

to forget that increased stress vulnerability and other forms of pathological and inappropriate

stress coping behaviors are also common brain disorders. These events can trigger errors in

the metabolic pathways.

39


Diabetes is complex and its intricate mechanisms can be subtly manipulated by yogic

practices. Physical and mental cleansing and strengthening is one of yoga‘s most important

achievements. What makes it so powerful and effective is the fact that it works in the holistic

principle of harmony and unification. According to medical scientists yoga therapy is

successful because of the balance created in the nervous system and endocrine system which

influence all other systems and organs of the body. Instead of treating the disease, it

eliminates the causative factors which is the effect of yoga as functional medicine.

The exciting part about the new science of genomics or especially nutrigenomics as stated by

Dr. Vincent Bellonzi “that you can change who you are, by how you treat your genes in

terms of changing the nutrients that we expose our genes to. Since it is not hard wired, it is

truly up to us to make the choice between choosing to take care by ourselves, as opposed to

be someone taking care of us and thus prevent the disease called diabetes, essentially created

by wrong lifestyle”.

40


HOW OBESITY LEADS TO TYPE 2 DIABETES: A PHYSIOLOGICAL

EXPLANATION

Dr V. SRINIVASAN MD 1

Genes and obesity are the two well-known factors which lead to type 2 diabetes. Of these,

genetic factor is very well understood by the fact that children born to diabetic parents have a

very low reserve of insulin secreting beta cells. So, they are likely to exhaust this reserve by

middle age if they have sedentary life and develop type 2 diabetes.

Regarding the contribution of obesity for the development of type 2 diabetes, no convincing

explanation is available so far. So, in my present talk, I will give a physiological explanation

for the same. It is well known that in obese persons there is down regulation of insulin

receptors. So, the secreted insulin circulates as unused insulin resulting in hyperinsulinemia.

When a continuous 24 hour insulin secretion was recorded both in normal and obese persons,

it was observed that as compared to normal persons the obese persons secreted twice the

amount of insulin.

While discussing the natural history of Type 2 diabetes, Text Book of Medicine by Price

mentions that hyperinsulinemia precedes the onset of Type 2 diabetes. This stage is also

called insulin resistance, because, in spite of hyperinsulinemia there is euglycemia. Further,

Chin-Jen et al have observed that altered cardiac autonomic function precedes insulin

resistance in metabolic syndrome. They explain this observation by stating that predominant

sympathetic activation leads to lypolysis which in turn increases free fatty acids.

This increase in free fatty acids blocks the action of insulin leading to hyperinsulinemia.

From the above, it can now be concluded that hyperinsulinemia will lead to exhaustion of

insulin secretion resulting in type 2 diabetes. This hyperinsulinemia can be either due to

down regulation of insulin receptors as observed in obesity or increased sympathetic activity

as observed in altered cardiac autonomic function.

Therefore, yoga therapy is recommended in pre-diabetic persons to counter both obesity and

increased sympathetic activity.

Director-Professor (Retd.) Dept. of Physiology, JIPMER, Pondicherry.

41

Proc Ntl Workshop -cum- Seminar on Yoga &Diabetes

A REVIEW OF RESEARCH STUDIES ON YOGA AND DIABETES

Dr B K SAHAY MD 1

Antiquity of traditional medicine dates back to over 4000 years, as evidenced in Ayurveda

(the science of life). The aim of traditional medicine according to Charak is to maintain the

health of healthy person and relieve the suffering of the sick- “Swasthasya swasthya

rakshanam aturasya vyadhi parimokshanam”.

The ancient Indian physicians had a sound knowledge of diabetes. They described the

clinical features and complications of diabetes vividly. Both Sushrut and Charaka

emphasized the importance of diet and exercise in the management of diabetes. They

categorized diabetes into 2 groups – the obese and the lean and prescribed strenuous

exercises for the obese diabetics.

The science of yoga is an ancient one. It is a rich heritage of our culture. Several ancient

books make a mention of the usefulness of yoga in the treatment of certain diseases and

preservation of health in normal individuals. It has now become the subject of modern

scientific evaluation. Apart from its spiritual philosophy, yoga has been utilized as a

therapeutic tool to achieve positive health and cure diseases. This concept is promoted in

hathayoga and ghatasthayoga by the yoga preceptors. Interest has been evinced in this

direction by many workers and studies on the effect of yoga on hypertension, diabetes,

asthma, obesity and other common ailments have been carried out.

Does yoga cure diabetes? This question is posed by many. The claim of yogic exponents that

yoga cures diabetes is perhaps an expression of the good control of diabetes achieved among

obese type 2 diabetics who also respond to diet and exercise. We carried out extensive well

designed studies to assess the effect of yoga in the treatment of diabetes as well as other

diseases. These studies were performed during the period 1978-1995 at the Vemana Yoga

Research Institute, Secundrabad and were published in different journals and presented in

various conferences. Today’s presentation is a review of the work done to assess the effect

of yogic practices in diabetics.

Eminent diabetologist and past president API. Former Professor of Medicine Osmania Medical

College and Chief Investigator Diabetes and Yoga Project, Vemana Yoga Research Institute,

Hyderabad.

42


Effect of Yoga on Fasting & Post Meal Blood

Glucose Cholesterol

0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

3 0 0

FBS PLBS CHOL

B e f o r e

3 M o n t h s

6 M o n t h s

n=108 **p<0.001 SAHAY 1993

Several other workers had done studies to assess the effect of yogic practices in diabetics. All

these studies highlighted the useful role of yogic practices in type 2 diabetics. However, these

studies were done in small number of patients over short periods and looked only at the

glycaemic levels.

We designed our studies to answer two main questions:

1) Does yoga play a role in the control of diabetes?

2) If so, what is the mechanism of action and its impact on the development of

complications?

With this in mind studies in normal healthy volunteers were carried out to assess the effect of

yogic practices on the biochemical and hormonal parameters, exercise tolerance and

performance of athletes. Studies were also carried out in the obese and diabetics with

hypertension. In diabetics the effect of individual yogic practices was assessed and useful

asanas were identified. These studies were both short term and long term follow up studies.

IN NORMAL VOUNTEERS IN DIABETICS

Biochemical and hormonal changes

Effect on exercise tolerance

Effect on performance of athletes

Effect on obesity and hypertension

Effect on lean body mass and body fat%

Pranayama

Yoga asanas (four groups)

Individual asanas

Acute experiments

Exercise tolerance

Long term follow up of cases

Studies in lean type 2 diabetics

Studies in elderly diabetics

Our earliest study assessed the effect of

pranayama on the blood sugar level in 50

normal individuals, which showed a

significant fall in the blood sugar levels

soon after the practice of pranayama.

In normal healthy volunteers the skinfold

43


Summary and Conclusions

Groups of Asanas

Optimum benefit

Dhanurasana and Ardha Matsyendra

Asana (d) Halasana and Vajrasana (b)

Slightly effectives

Naukasana and Bhujangasana (a)

Control worsened with

Yoga Mudra and Shalabasana

Effect of Yoga on the

HBA1 and Drug Score

0

2

4

6

8

1 0

1 2

1 4

H BA1 Drug Score

B e f o r e

3 M o n t h s

n=108 *p<0.05 **p<0.001

10.41

8.45*

1.71

1.08**

thickness was significantly reduced with increase in the lean body mass, without any

significant change in the weight of the individuals. These results prompted us to study the

effect of pranayama and other yogic practices on diabetics.

26 NIDDM and 4 IDDM patients were studied for one

month. They practiced 4 types of pranayama for 30 minutes

followed by shavasana for 15 minutes. They developed a

sense of well being within 7 to 10 days and showed a

significant fall in fasting and post-prandial blood glucose

values. In 17 patients the requirement of drugs came down

significantly. Insulin assays were done in 5 of these 26

NIDDM patients. There was normalization of the I/G ratios.

GROUPS OF ASANAS:

Some asanas have been identified as useful for patients with diabetics in earlier studies. Out

of these we chose 8 asanas which could be performed by subjects of all age groups for

assessing their effectiveness. In order to assess the effect of individual asanas, patients were

randomly allotted to different groups and they performed yogic practices of that group for 45

minutes each day followed by relaxation practices i.e. shavasana and makarasana. The

adjacent table gives us different groups of

asanas and their effect on blood sugar both

fasting and post-prandial. These studies

revealed that optimum control of diabetes

was achieved by practising dhanurasana and

ardhamatsyendrasana while halasana and

vajrasana as well as bhujangasana and

naukasana were also effective. Yogamudra

and shalabasana worsened the diabetic status.

When studied individually, dhanurasana was most effective. Why some of these asanas had a

deleterious effect is not clear. In all our subsequent studies, we have incorporated

dhanurasana, ardhamatsayendrasana, bhujangasana, naukasana, halasana, vajrasana and

paschimottanasana along with pranayama.

44


ROLE OF YOGIC PRACTICES IN SECONDARY FAILURE TO OHA

SAHAY BK. Et al

No.of Patients : 10 Mean height :164.

Mean Duration : 5.45 1SD + : 6.27

1SD+ : 4.00 Mean Weight :60.85

1SD + :9.61

MEAN BSL

mg%

INITIAL 30 DAYS 60 DAYS 90 DAYS

FASTING 146.10 113.34* 109.29* 101.29**

1SD 38.61 34.23 28.65 28.85

POST

PRANDIAL

240.30 173.00* 154.00* 150.20*

1SD 58.94 55.07 30.07 27.56

DRUG SCORE 1.80 0.85

1.60 0.71

*p = <0.05

**p = <0.001

Lean NIDDM - Yogic Practices

Before Yoga After Yoga

Choles terol (mg/dL) 208.70 38.27 194.67 20.00

Triglycerida (mg/dL) 130.50 22.22 105.33 17.74

HDL (mg/dL) 44.30 6.25 47.83 5.42

LDL (mg/dL) 136.30 42.03 121.17 29.06

VLDL (mg/dL) 26.73 4.74 22.50 6.83

FFA (mu/L) 482.20 82.02 420.20 64.63

108 patients with type 2 diabetes

were studied for a period of 6

months. All developed a sense of

wellbeing and showed significant

fall of fasting and post-prandial

blood sugar values with better

control and significant fall in

glycosylated hemoglobin and drug

requirements. There was significant decrease in body fat and increase in lean body mass.

Studies in patients with secondary OHA failure: Patients who were in poor control with

maximum dose of sulphonylureas or combination therapy were subdivided into 2 groups

according to the duration of below and above 6 years. Patients in both groups showed

improvement in their glycaemic control with reduction in the dosage requirement.

In a study on elderly diabetics, 20 subjects aged more than 60 years with a mean age of 66

years were followed for 3 years. They achieved good glycaemic control maintained over the

period of 3 years. No long term complications of diabetics were encountered.

Profile of Elderly Diabetics

Practising Yoga

Parameters Initial 1 yr 2 yr 3 yr

(X + 1sd)

FBS (mg/dl) 137.16+29.80 91.42+18.98 82.53+15.08 85.30+15.98

PPBS (mg/dl) 199.79+33.86 139.04+27.55 139.04+27.55 142.00+28.00

Drug score 1.47+0.84 0.55+0.91 0.50+0.91 0.34+0.47

N=20, Mean age 66,44 N=20, Mean age 66,44 ++ 5.84 yr, Mean height 164.81 5.84 yr, Mean height 164.81 ++ 8.17 cm, 8.17 cm,

Mean weight 63.39 Mean weight 63.39 ++ 9.37 kg, Mean duration 12.79 9.37 kg, Mean duration 12.79 ++ 5.18 yrs 5.18 yrs

STUDIES ON LEAN DIABETICS:

A subset of lean diabetics with BMI less

than 18 were studied. There was

improvement in glycaemic control with

reduction in body fat content and

improvement in lean body mass. There

was reduction in cholesterol,

triglyceride, LDL and free fatty acid levels and an increase in the HDL levels.

45


LEAN NIDDM EFFECT OF YOGIC PRACTICES

Mean AGE: 44 YEARS 9.89, Mean Ht. 165.9 +8.1,

Mean Wt. 52.38 6.2

Before Yoga After Yoga

BMI Mean 1SD 18.96 0.96 18.70 1.34*

FBS Mean 1SD 56.10 62.02 95.94 31.39 **

PLBS Mean 1SD 259.20 82.51 151.60 44.69 **

GllyHb Mean 1SD 10.56 3.82 9.07 3.34

*P <0.05, ** P <0.01

Effect of Pranayamaon Diabetes

Patients with Hypertension

(n=14)

BP (mmHg) Initial 30 days 60 days 90 days

Systolic

X 144.00 136.00 135.00 130.70

+ 1SD 18.14 7.50 11.10 10.10

P <0.05* <0.05* <0..05*

Diastolic

X 95.70 90.00 88.50 86.90

+ 1SD 6.44 3.77 4.90 5.03

P <0.05* <0.05* <0.05*

Long term follow-up studies: 32 NIDDM and 3 IDDM patients who attended the institute

regularly were studies for a period ranging from 2 to 7 years. All of them showed a

significant fall in the fasting and post- prandial blood glucose values within 3 months and

continued to have a smooth and good control of diabetes during the period of the study as

evidenced by a normal glycosylated

hemoglobin and blood glucose levels.

The drug requirements were

significantly reduced. There was a

significant increase in the max

treadmill time from 8 min to 12 min.

These patients were free from episodes of diabetic ketoacidosis, hypoglycemia and did not

develop any vascular complications. Infection rate was also negligible.

All these studies show that in different subsets of patients - obese, lean and elderly with

different durations of diabetes, there was improvement in glycaemic control which persisted

over long periods of time with protection from long term complications.

EFFECT ON COMORBID CONDITIONS

Hypertension is commonly encountered in patients with diabetes and has a significant role in

the development of both microvascular and macrovascular complications. Along with

hypertension dyslipidemia is also equally common. Hence in our studies we assessed the

impact of yogic practices on these co-morbidities.

a) Hypertension: Patients with hypertension were advised pranayama and shavasana. 20

non diabetic patients with moderately elevated BP had reduction in both systolic and

diastolic blood pressure after 3

weeks of yogic practices and the

blood pressure was maintained at

normal levels with significant

reduction in the dosage

requirement of anti-hypertensive

drugs. Similar reduction in the

46


systolic and diastolic blood pressure and the fasting and post-lunch blood sugar was

observed in patients with diabetes and hypertension. The blood pressure came under

control in 15 days and the effect was sustained even in studies upto 3 months. Patients

were free from cerebro-vascular, cardiovascular and renal problems. EFFECT OF YOGA

LIPID PROFILE IN DIABETICS

* P <0.05

** P <0.01

BEFORE AFTER

CHOLESTEROL 189.70 30.27 188.80 25.42

TRIGLYCERIDES 129.45 44.00 106.10 39.73*

HDL 44.44 4.95 46.55 5.05 **

LDL 118.68 35.45 117.90 31.78

VLDL 25.87 8.98 21.22 7.83*

FFA 416.3 83.97 399.0 89.89

b) Dyslipidemia: The impact on lipids was studied in the different groups of patients. The

effect of yoga asanas on lipoprotein profiles was studied. There was a significant

decrease in the free fatty acids, LDL and VLDL cholesterol and increase in HDL

cholesterol. These changes suggest improvement in the insulin sensitivity following

yogic practices.

EXERCISE TOLERANCE: Comparative studies of the effect of yoga and physical

exercise on the exercise tolerance in normal healthy volunteers as well as athletes showed

improved exercise tolerance and postponement of the anaerobic threshold with both, but with

yogic practices this occurred with a significant reduction in the minute ventilation and

oxygen consumption. Our diabetic patients also showed improvement in exercise tolerance

after 2 months of yogic practices with an ability to carry out exercise for longer periods.

PLASMA INSULIN: Our studies revealed a reduction in the fasting insulin levels and a

shift of the peak level of insulin to the left. There was a normalization of I/G ratio with a

reduction in free fatty acid levels, suggesting better peripheral utilization of insulin and

reduction in insulin resistance. In a study on 5 patients with uncontrolled diabetes, the effect

of yogic practices on the insulin receptors was studied. At the end of 4 weeks, there was a

47


Effect pf Yogic Practices on CMI in

NIDDM

(Lymphocyte Transformation Test)

SL - Stimulation Index to mitogen

0

5

1 0

1 5

2 0

2 5

1 2 3 4

B e f o r e Y o g a

A f t e r Y o g a

Before After

x 13.8 14.76

SD 4.25 3.28

14.7

19.5

8.2

12.3 12.4

17.2

20

11.7

FOLLOW UP OF CHILDREN OF DIABETICS

5 YEARS ON YOGA WITHOUT

YOGA

NO. DEVELOPED

DIABETES

1/24 10/56

FOLLOW UP OF CHILDREN OF DIABETICS

5 YEARS ON YOGA WITHOUT

YOGA

NO. DEVELOPED

DIABETES

1/24 10/56

significant rise in the insulin receptors although the blood sugar values did not yet normalize,

indicating a reduction in insulin resistance and improved insulin sensitivity.

EFFECT OF PRANAYAMA ON LUNG FUNCTIONS IN DIABETICS: Lung functions

(FEVI, FVC, PEFR, FEVI/FVC and FEVI/Transfer factor) in 20 diabetics both IDDM and

NIDDM were carried out before and after 3 months of practice of pranayama and were

compared with 5 diabetic subjects who did physical exercise instead of yoga for 3 months.

The analysis of the data showed that the lung functions improved significantly while blood

sugar and glycated hemoglobin reduced significantly in the study group as compared to the

control group of diabetics of comparable age and severity who did other physical exercise

instead of yoga.

EFFECT OF YOGA PRACTICES ON CMI IN

TYPE 2 DIABETES

These were carried out in 4 patients; the practice

of yoga improved the cell mediated immunity as

evidenced by lymphocyte transformation test

given in adjacent figure.

ROLE OF YOGIC PRACTICES IN PREVENTION OF TYPE 2 DIABETES

Overall, yogic practices increase lean body mass and decrease body fat percent and thereby

improve insulin sensitivity and reduce insulin resistance which is the major abnormality in

type 2 diabetes preceding the development of overt diabetes by several years. Therefore we

postulate that these beneficial effects on the insulin kinetics prevents beta cell exhaustion

thereby preventing the development of type 2 diabetes.

48


Following yogic practices

The body fat % comes down

Lean body mass increases

Upregulation of insulin receptors

Improved insulin sensitivity and

decreased insulin resistance

ROLE OF YOGIC PRACTICES IN TYPE 1 DIABETES:

Similar studies were done in type 1 diabetics. Their number was small. However, the

following observations could be made:

1. They showed improvement and better control of their diabetes with reduction in

insulin requirement.

2. Three of these patients who had brittle diabetes with wild fluctuations in their

glycaemic status showed significant improvement following yoga and got stabilized,

thus blunting their brittleness.

SUMMARY AND CONCLUSIONS:

These studies have so far confirmed the useful role of yoga in the control of diabetes

mellitus. Fasting and postprandial blood sugar levels came down significantly. Patients

developed a sense of well being within 10 days with lowering of dosage of drugs and

diminished incidence of acute complications like infection and ketosis. There were

significant changes in the insulin kinetics and those of counter-regulatory hormones like

cortisol. There was a fall in free fatty acids suggesting a better insulin sensitivity and

decrease in insulin resistant. There is a beneficial effect on the co-morbid conditions.

We have identified the following asanas to

be useful in controlling diabetes:

dhanurasan, ardhamatseyendra asana,

halasana, bhujangasana, naukasana,

vajraasana and paschimottanasana. These

can be practiced along with pranayam.

We conclude that yogic practices are useful

in all age groups and can be performed in

all seasons.

49


BENEFICIAL EFFECTS OF A YOGA BASED LIFE STYLE IN

IMPROVEMENT OF RISK FACTORS FOR CORONARY ARTERY

DISEASE

Dr. SHANTHARAM SHETTY MD 1

Increasing understanding of various risk factors as causative agents of coronary artery

disease (CAD) has generated a lot of interest in prevention and regression of arterial disease.

Many researchers have proved that proper lifestyle has great potential in prevention &

treatment of cardiovascular diseases. Evaluation of improvement in risk factors like faulty

diet, lipid profile, body mass index (BMI), waist to hip ratio (WHR), stress, diabetes mellitus

(DM) and blood pressure (BP) in the ischemic heart disease patients was done in a study

namely “CARING HEART PROJECT”. This prospective controlled, open trial included

angiographically proven coronary artery disease patients (71 patients in study group and 42

patients in control group). All these patients had multiple risk factors for CAD. They were

followed for the period of one year. Patients were assessed at base line and at the end of one

year after following yogic lifestyle and yogic sattvik diet. The primary efficacy variables

were percent change from baseline at one year in total calories in diet, fat content in diet,

complex carbohydrate content in diet, BMI, WHR, lipid profile, stress levels, blood glucose

and blood pressure.

STUDIES ON RISK FACTORS FOR CAD

Syndrome X, faulty diet, wrong habits, sedentary and stressful lifestyle are some of the

etiological factors responsible for CAD. Risk factor modification is the latest strategy being

implemented for preventing CAD. Yoga based lifestyle modifications along with yoga diet

have earlier shown to have been beneficial in CAD in small number of patients. Ornish et al

(2000-2003) have conducted extensive studies on the effect of lifestyle changes based on

yoga philosophy and yogic diet on reversal of CAD. Lifestyle Heart Trial (LHT) and

Multimember Lifestyle Demonstration Project (MLDP) were 2 classic clinical trials

developed to assess improvement in medical risk factors and quality of life in subjects with

Consultant Physician and Yoga expert, The Yoga Institute, Mumbai.

50


coronary artery disease, after risk factors modifications. The MLDP was carried out to assess

generalizability of lifestyle change program to different geographic regions of United States

and women with heart disease. These trials included comprehensive lifestyle changes (diet,

exercise, stress management and social support) for patients of CAD and the effects of these

changes on cardiovascular risk factors & events were assessed.

Manchanda et al, 2000 studied the effect of a yoga lifestyle and yoga diet on coronary artery

disease. The study consisted of 42 men with CAD who were randomly assigned to a yoga

intervention group or a control group and were followed for one year. The yoga lifestyle

program included a strict control of risk factors, weight reduction, increased physical

activity, dietary modifications and stress management. This resulted in favorable changes in

lipid profile and in CAD in subject group in comparison to control group.

THE YOGA INSTITUTE STUDY – CARING HEART PROJECT

The Yoga Institute, Santacruz, Mumbai, India has been working on similar lines for a

number of years. Many cardiac patients have benefited from this 90 year old institute. Seeing

the beneficial effect of yoga based lifestyle and yogic diet, the study called CARING

HEART PROJECT was initiated as mentioned earlier. A yoga based lifestyle primarily deals

with balanced state of mind and healthy body. This is achieved with the help of yoga

philosophy, yoga techniques and yogic sattvik diet. The philosophy of better living through

yoga is based on principles from Patanjali’s yoga sutra and Sankhya philosophy. The yogic

sattvik diet could be described as a lacto-vegan diet that is high fiber, low fat, moderate

protein and high complex carbohydrate diet including 10% of the total calories as fats with

restriction of all non–vegetarian, processed foods and alcohol. This was associated with

yoga techniques like yoga asana and meditation which helped in better compliance of the

diet. Asanas used were sukhasana, vakrasana, yastikasana, savasana and pranayama. The

diet was based on nutritionally balanced diet as prescribed by the National Institute of

Nutrition, Hyderabad. The dietary changes were modifications of the patient’s existing diet,

thus ensuring good patient compliance. The control group was managed by conventional

methods i.e. risk factor control and American Heart Association Step 1 diet.

51


MATERIAL AND METHODS:

The Study Group - This prospective controlled, open trial included angiographically proven

coronary artery disease patients (71 patients in study group and 42 patients in control group),

with multiple risk factors. Both the groups were comparable to start with in terms of age and

anthropometric parameters. The study was approved by the Ethics Committee of the Yoga

Institute. Written informed consent was obtained from all the participants prior to initiating

the study. After initial screening, ECG, X-ray and biochemical tests were performed. All

were asked to continue drugs as per their physician’s advice except statins. No other

concurrent therapy for control of any of the risk factors was permitted.

Baseline Assessment - All the participants were subjected to baseline assessment like

myocardial perfusion imaging (MPI) test, angiography, biochemical tests, anthropometric

measurements, psychological assessment and clinical evaluation. The study group was

closely monitored and trained at the Yoga Institute and control group was followed as per

conventional norms of treatment at an outside venue.

Guidelines to participants - All the participants from the study group were told to undergo

yoga training in a two day yoga heart camp. In this camp, people were given basic

knowledge of CAD, yoga based better living, and yoga techniques. Later they were enrolled

in the programme. The cardiologist, dieticians and yoga experts gave talks on different

subjects. Regular follow up and monitoring was done by volunteers. The participants from

the control group were followed at different venue by doctors as per conventional method of

treatment without yoga.

Questionnaire - A comprehensive pre-tested questionnaire was developed to collect

information about dietary patterns and frequency of consumption of various foods.

Nutritional status was assessed using dietary parameters such as 24-hour food recall, food

frequency and consumption. This was further compared with measurements of weight and

body mass index.

Dietary Instructions - A record of biochemical parameters was analyzed and related to

anthropometrical measurements and dietary intake. For reduction in fat content, complete

stoppage of non vegetarian foods and overall reduction of fried foods was advised. Patients

were also encouraged to take high carbohydrate (mostly complex carbohydrate providing

52


70% of calories).They were advised to take high soluble fiber diets consisting of vegetables

and fruits, sprouted pulses, soybeans and fenugreek seeds. In addition, the diet advised was

rich in antioxidants (carrots for beta-carotene, fruits for vitamin C, nuts like almonds and

walnuts for vitamin E and flavenoids from colored fruits and vegetables and omega 3 fatty

acids from flaxseeds).Change from refined sunflower oil to unrefined groundnut oil or olive

oil was advised. Artificially flavored ,packed foods, de-vitaminized or sprayed food ,frozen

food, colas, fast food, chocolates with high sugar and cream content, puddings and pies, full

fat ice creams and biscuits made with refined flour were excluded.

Periodic Assessments - Patients from both the groups were assessed at 1, 3, 4, 6, and 12

month’s period and simultaneously counseled individually and with their spouses. Changes

in the lifestyle and diet were gradual. These were supported by regular hands on training on

yoga techniques and illustrative recipes and menus with known nutritional values. Group

counseling for stress and sattvik diet was done. Patients maintained a daily diary which

included details of daily routine, menu, quantity of food consumed, timing of the meal, and

experienced emotions. Support therapy was used as an integral part of the program. Family

and spouses were met at regular intervals and the concept of family as a unit was explained.

Tests and Analysis - All the tests done during baseline assessment were repeated at the end

of the study. For statistical analysis, group variables on a continuous scale were expressed as

mean along with standard deviation and categorical data frequency with percentage. all

statistical tests were two tailed and acceptance level of statistical significance in overall

analysis was P-0.005. Comparitive statistical analysis were carried out using ANNOVA.

OBSERVATIONS:

Calories - The average total calories were 33.90 among Control group and 34.58 in Study

Group at basal which was same and difference was not statistically significant At the end of

treatment the total calories significantly reduced by 31.5% in study group as compared to

23% in the controls.

Fats - In the beginning the average fats were 26.11 and 26.71 respectively in control and

study group which was same and difference was not statistically significant. At the end the

total fat content also markedly reduced by 47.2% as compared to 25.7% in the control group.

53


Carbohydrates - The mean carbohydrates were 54.09 among Control group and 52.71 in

study group at basal which was same and difference was not statistically significant. At the

end the complex carbohydrate content increased in the total diet by 24.1% as compared to

only 11.8% in the controls. Though there was increase in both the groups, if you compare the

increase was more in study group than control.

Body Mass Index - All overweight patients achieved near normal ideal body weights thus

resulting in near normal BMI. The body mass index showed a fall of 4.2% in study group

which was more as compared to 2.9% in control.

Nutritional Values - Average nutrition values (processed food) were 3.48 among Control

group and 3.37 in Study Group at basal which was same and difference was not statistically

significant. After treatment, at the end of 1.5 month only, mean levels were significantly

increase in study group but in control group change were observed at the end of 3.5 month.

At the end of 1 year, increase was 95.5% in study which were also significant as compared to

52.0% in control group. The average nutrition levels were 6.71 and 6.89 respectively in

control and study group at basal which was same and difference was not statistically

significant. After treatment, at the end 3.5 month only in study group mean nutrition level

showed significant increase as compared control at the end of 8.5 month. At the end of 1

year, increase was 23.9% in study group as compared to 23.2% among control.

Blood Sugar - The mean fasting blood sugar value decreased from 196 mg% to 156 mg% in

subject group as compared to 190 mg% to 174 mg% in the control group. Post prandial blood

sugar value decreased from 260 mg% to 186 mg% in subject group as compared to 290 mg%

to 240 mg% in control group.

Blood Pressure - Mean BP in subject group decreased from 166/94 to 136/86 mm Hg in

comparison to control group which changed from 160/92 to 156/90 mm Hg. There was

significant change in the anxiety level, personality traits and quality of life, after the program

in the study group compared to the control group.

Total cholesterol - There was significant reduction in mean cholesterol level from 247.2 to

184.8 in the study group as compared to the decrease from 223.5 to 213.84 in controls.

54


DISCUSSION AND CONCLUSION:

The diabetic patients showed better balance in blood glucose levels, as shown above with the

help of foods low glycaemic index foods (such as fenugreek seeds, sprouts) as compared o

control group.

Blood pressure was better controlled as shown above due to weight reduction and cessation

of processed foods and a diet high in fiber and potassium from fruits as compared to the

control group.

At the end of the study period all overweight patients were near normal to their ideal body

weights and there was significant reduction of serum cholesterol, LDL cholesterol and

triglyceride, because of the high fiber, low fat, moderate protein and high complex

carbohydrate diet as compared to the control groups.

Dietary modifications as per yogic way showed a significant improvement in overall risk

factors, proved by improvement in MPI status and angiography.

Overall yoga based life style which included yogic diet and yoga techniques had a positive

effect on control of risk factors. These effects were concordant with improvement in

psychological parameters, myocardial perfusion status and coronary artery lesions as proved

by different tests.

55


YOGIC MANAGEMENT OF OBESITY

DR. SHARMA VK1

ABSTRACT: Rishis developed yoga as a moksha shastra and healthy living is its by-product.

Being the best form of healthy lifestyle ever designed, yoga is of immense relevance in

today's world. Obesity is the medical condition in which excess body fat has accumulated to

the extent that it may have an adverse effect on health, leading to health problems and

reduced life expectancy. Currently, it is the most common nutritional or metabolic disorder in

the developed countries. In India, about 20 % of children from public schools are over-

weight. Childhood obesity is already an epidemic worldwide and is further rising at an

alarming rate. Obesity is measured by calculating body fat percentage (BFP), skin fold

thickness, waist-hip ratio (WHR) and body mass index (BMI). Although, causes of obesity

include genetic factors, age, metabolic disorders and drugs, the prime reason of obesity

epidemic is faulty lifestyle and chronic stress of modern life. Yogic management of obesity

includes 1) Lifestyle modification. 2) shodhana kriyas / detoxification process 3) breathing

rectification 4) yogic practices including asanas, bandhas, mudras and meditation. When all

these components are followed over a period of time, they can help in significantly reducing

the obesity. Detoxification removes toxins from the body, asanas and pranayams increase the

strength and endurance of muscles, aerobic capacity, bring balance in neuro-endocrine axis

and meditative techniques decrease the stress levels, thus reducing anxiety and preventing

binge eating. It is clear that there is a lot of scope of exploring yogic techniques in prevention

and management of lifestyle disorders such as obesity.

INTRODUCTION:

The word 'Yoga' is derived from Sanskrit word ‘yuj’ which means to unite and refers to the

union of individual soul (atma) with universal Soul (Parmatma). The science of yoga deals

with a man holistically, as this is the only science which takes into consideration both the

‘psyche’ and the ‘soma’ aspects of human framework. Our ancient cultural heritage of yoga

has gained tremendous momentum in present times to become universally accepted

Assistant Professor, Department of Physiology, JIPMER, e-mail: [email protected]

56


philosophy as a way of life which gives the practitioners a healthy body, sound mind and

alleviates stress and produces relaxation. Yoga was basically developed as a moksha

shastra and healthy living is its by-product. Hence, yoga is of immense relevance in today's

world. Scientifically, it is mind-body technique involving breath control, physical exercises

and meditation which promote physical, mental, social and spiritual well being. There is a

large body of scientific evidence that documents promotive, preventive and curative

potential of yoga. Today, it is one of the top ten complementary and alternative medicine

(CAM) systems practiced worldwide and its use is progressively increasing. Obesity is the

medical condition in which excess body fat has accumulated to the extent that it may have

an adverse effect on health, leading to health problems and reduced life expectancy.

Obesity was virtually unknown till the beginning of 20th

century but today it is the leading

preventable cause of death worldwide and one of the most serious public health problems.

Currently, it is the most common nutritional or metabolic disorder. It is a double tragedy for

the world as half of the world is suffering from chronic starvation while rest of the

population is suffering from the epidemic of obesity and its related disorders. Obesity is a

complex condition with serious social and psychological dimensions that affect virtually all

age and socio-economic groups and threaten to overwhelm both developed and developing

countries. Today, one in three of the world’s adults is overweight and one in 10 is obese.

WHO estimates that by 2015, the number of obese adults will rise to nearly 2.3 billion —

equal to the combined populations of China, Europe and the U.S. The magnitude of

overweight ranges from 9% to 27.5% and obesity ranges from 1% to 12.9% among Indian

children1.

Childhood obesity is already a global epidemic and is further rising at an

alarming rate.

MEASUREMENT OF OBESITY:

Obesity is measured by calculating body fat percentage (BFP), skin fold thickness (SFT),

waist-hip ratio (WHR) and body mass index (BMI). BMI defines people as overweight

(pre-obese) when their BMI is between 25 kg/m2 and 30 kg/m

2, and obese when it is greater

than 30 kg/m2. Although, normal range for southeast Asian population is suggested between

18.5 – 22.9 as it has been found that risk of obesity-related diseases starts rising much

57


earlier in this population as compared to their western counterparts. BMI is an easy to

measure and useful parameter but can be misleading if not considered along with WHR and

BFP.

CAUSES OF OBESITY:

Causes of obesity include genetic factors, age, metabolic disorders and drugs. Prime reason

of obesity epidemic is faulty lifestyle and chronic stress of modern day life. Faulty lifestyle

includes following behavioral attitudes:

i) Consuming too many calories: Today, the trend of consuming foods which are calorie

dense, overcooked and highly processed but nutritionally poor is increasing worldwide.

Since, these types of foods have very less fiber content there is tendency to overeat them

with little feeling of satiation. According to yogic literature, these foods items come in the

category of rajasic and tamasic food type. Scientific evidence also suggests that prolonged

consumption of such food items can lead to various types of carcinomas e.g. colon cancer.

ii) Leading a sedentary lifestyle: With the advent of all modern day facilities of transport

and communication, people are leading more sedentary life. Lack of physical activity is the

most significant factor in contributing to childhood obesity. Too much time is spent on

sedentary behaviors like computer games and watching TV which may equal, or even

exceed, diet quality as important contributors to overweight in adolescence.

iii) Excessive smoking, intake of beverages like tea, coffee, alcohol, colas: Consumption of

these substances increase sympathetic activity thereby, causing persistent rise in the stress

levels of the individuals

iv) Inadequate sleep: Sleep deprivation has been hypothesized to contribute toward obesity

by decreasing leptin, increasing ghrelin, and compromising insulin sensitivity. Scientific

studies strongly suggest that sleep duration is associated with obesity and weight gain2

.

Also, more and more people are working in various professions which force them to work

in night shifts which is detrimental to their health

v) Modern day lifestyle exposes many individuals to constant stress which is taking a

heavy toll on them. Anxiety disorders and depression as well as metabolic disorders

58


including obesity, type 2 diabetes mellitus and arteriosclerosis have all been linked to

stress. Also, stress has been linked to biochemical changes that can trigger food cravings

and binge eating episodes, ultimately leading to obesity.

OBESITY AS A RISK FACTOR:

Obesity has been implicated as a risk factor for large number of diseases such as diabetes

mellitus, hypertension, coronary artery disease, psychiatric disorders including depression

and poor self esteem, cancers of breast, liver, pancreas and colon, cholelithiasis,

hypoventilation syndrome and osteoarthritis 3

YOGA IN MODERN MEDICINE:

Mind-body medicine is now an established form of treatment. Four basic principles of yoga

therapy for obese patient are: 1) Lifestyle modification. 2) Shodhana kriyas / detoxification

process 3) Breathing rectification 4) Yogic practices including asanas, bandhas, mudras and

meditation.

1) Lifestyle modification is essential for bringing healthy attitudes and practices which can

help in the prevention and treatment of obesity. It involves restructuring of life schedule

including following important components:

a) Cessation of smoking, alcohol intake and limiting the intake of beverages like tea

& coffee etc. These beverages can be replaced with traditional beverages like flower

and fruit juices, lassi, kanji, sattu etc which will be nourishing and non-addictive in

nature

b) Adopting active lifestyle. Human beings work best when their bodies are active

and mind calm, but today reverse is true. We hardly move around and our minds

keep wandering creating continuous stress on us. Yoga practice is dynamic in nature

and we should look for opportunities of physical and mental activity in our day-to-

day life. Yoga practice for nearly 30 minutes to one hour daily can be a safe and

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effective means to reduce the weight of obese individuals. Yoga should be

introduced at the age of seven onwards.

c) Diet rectification (mitahara): Sattvic diet includes fresh sprouts, vegetables, cereal

grains, fruits, legumes, nuts and unpasteurized raw honey. According to ayurveda,

this diet inculcates sattva guna, leading to clarity and equanimity of mind and also

nourishes the body. According to Hathayogapradipika, food should be agreeable,

easily digestible and one should always eat food only up to 75% of stomach filled

with remaining 25 % empty.

d) Healthy, positive thinking. Regular yoga practice regularly naturally helps in

developing positive outlook in every situation of life

e) Ensuring adequate night sleep of 6-8 hours at fixed hours, preferably following

the old age proverb of “Early to bed and early to rise” as much as possible.

2) Shodhana kriyas / detoxification process: Yoga gives utmost importance to the

purification of mind and body for the ultimate transformation of self. Purification process

removes accumulated toxins, impurities and diseases that tranquils the restless mind &

regulates the body. It includes the practice of dhauti, basti, neti, trataka, nauli and

kapalabhati. Dhauti cleans the entire digestive tract, basti and shankhaprakshalan

completely wash the bowel, neti maintains healthy secretary and drainage mechanism of

ear, nose and throat. Nauli kriya tones the abdominal muscle, excretory and digestive

organs while kapalabhati kriya improves the functioning of respiratory and digestive

systems.

3) Breathing rectification: Pranayama means expansion and regulation of prana. Prana is

the vital energy in the body. On subtle levels, prana represents the pranic energy

responsible for life or life force, and ayama means expansion and control. One can control

the rhythms of pranic energy with pranayama and achieve healthy body and mind.

Although pranayama techniques manipulate breathing in different rhythms and patterns,

emphasis is on deep and slow breathing that reduces dead space ventilation, increases

oxygenation of tissues, strengthens chest muscles and improves cardio-respiratory reflexes.

Most useful pranayamas for obesity disorder are surya bhedi, bhramari, nadi-shodhana and

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http://en.wikipedia.org/wiki/Cereal_grain

http://en.wikipedia.org/wiki/Cereal_grain

http://en.wikipedia.org/wiki/Legume

http://en.wikipedia.org/wiki/Nut_%28fruit%29

http://en.wikipedia.org/wiki/Honey

http://en.wikipedia.org/wiki/Sattva

http://en.wikipedia.org/wiki/Guna

http://en.wikipedia.org/wiki/Clarity

http://en.wikipedia.org/wiki/Upeksa


bhastrika. Suryabhedi and bhastrika pranayamas stimulate sluggish metabolism and

improve cardiac functioning and digestion 4, 5

. Nadishodhana literally means “channel

cleaning”. Its regular practice increases parasympathetic activity 5 which produces relaxed

mind, soothes anxiety, de-stresses the body, balances left and right hemispheres and

promotes clear thinking. Likewise, bhramari pranayam also relaxes the mind and increases

parasympathetic activity. Daily practice of pranayama has been hypothesized to alter the

functioning of hypothalamic satiety center, thereby reducing binge eating episodes and

reducing anxiety levels

4) Asanas, bandhas, mudras and meditation: Asanas represent third limb of ashtanga yoga.

These are special postures that stabilize the mind through static stretching. They are

somato-psychic in nature which means various reflexes are stimulated by adopting different

yogic postures which ultimately affect the neuro-endocrine axis and mind of the

practitioner. Set of asanas are special form of low impact exercises, rhythmic in nature with

every flexion followed by extension associated with breath coordination. Practice of asanas

causes gentle massaging of visceral organs and increases microcirculation in the tissues. It

also increases the strength, endurance and flexibility of the body. Under proper supervision

and using common sense, practice of asanas is totally safe and can be done even by

morbidly obese and inflexible patients. Main asanas prescribed to obese patients will vary

according to their suitability but usually include: suryanamaskar, tadasana, katichakrasana,

trikonasana, pawanmuktasana, sarvangasana, matsyasana, halasana, bhujangasana,

dhanurasana, ushtrasana, mandukasana, vajrasana, paschimottanasana, ardha

matsyendrasana and relaxation postures such as makarasana and shavasana. According to

principle of Viniyoga, all asanas should be practiced within 80 % limit of comfortable zone.

Various bandhas & mudras are also useful in balancing neuro-endocrine axis of the body.

According to Patanjali, goal of meditation is chita-vritti -nirodha i.e. control of disturbances

activities of mind. Regular practice of meditation has been scientifically documented to

reduce sympathetic activity, balance neuro-endocrine axis and decrease stress and anxiety

levels 6.

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CONCLUSION: To summarize, various components of yoga therapy act through different

mechanisms in concert to optimize the functioning of body and mind and thereby reduce

the obesity of the patients. Detoxification/ shodhankriyas remove toxins from the body,

asanas and pranayams increase strength and endurance of muscles, aerobic capacity and

bring balance in neuro-endocrine axis. Meditative techniques decrease stress levels

reducing anxiety and preventing binge eating. When all these components are followed

over a period of time, they help in significantly reducing obesity. Therefore, there is a lot of

scope of exploring yogic techniques in the prevention and management of lifestyle

disorders such as obesity.

REFERENCES:

1. Vohra R, Bhardwaj P, Srivastava JP, Srivastava S,Vohra A. Overweight and obesity

among school-going children of Lucknow city. J Family Community Med. 2011

May-Aug; 18(2): 59–62.

2. Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB. Inadequate sleep as a

risk factor for obesity: analyses of the NHANES I. Sleep. 2005 Oct;28(10):1289-96.

3. Obesity: Preventing and managing the global epidemic.Technical Report Series No.

894. Geneva: WHO; 2000. World Health Organization.

4. Veerabhadrappa SG, Baljoshi VS, Khanapure S, Herur A, Patil S, Ankad RB,

Chinagudi S. Effect of yogic bellows on cardiovascular autonomic reactivity. J

Cardiovasc Dis Res. 2011; 2(4):223-7.

5. Telles S, Nagarathna R, Nagendra HR. Physiological measures of right nostril

breathing. J Altern Complement Med. 1996 Winter;2(4):479-84.

6. Jovanov E. On Spectral Analysis of Heart Rate Variability during Very Slow Yogic

Breathing. Conf Proc IEEE Eng Med Biol Soc. 2005; 3:2467-70.

7. Dalen J, Smith BW, Shelley BM, Sloan AL, Leahigh L, Begay D. Pilot study:

Mindful Eating and Living (MEAL): weight, eating behavior, and psychological

outcomes associated with a mindfulness-based intervention for people with obesity.

Complement Ther Med. 2010; 18(6):260-4. Epub 2010 Nov 11.

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IMPROVING AGNI AND APANA VAYU IN DIABETICS

Dr. N. CHANDRASEKARAN, MBBS 1

Diabetes Mellitus is an ailment primarily originating from the Pranamaya kosha and its

effects are felt in all the other koshas. Since the problem is originating from Pranamaya

kosha, the therapeutic approach should focus on the balancing of the prana system. This is

done by primarily working with breathing. All the yoga techniques that are used to bring out

the therapeutic effect are appropriately modified to have a focused effect on the prana

system.

FOCUS 1: TO WORK ON AGNI:

According to yoga and ayurveda texts, there are different types of agni in the human

constitution which are responsible for digestion, assimilation and proper integration into the

constitution. The activities of the agni are regulated by the prana system in the constitution.

The prana that are mainly involved in these activities are samana and vyana. Any imbalance

in these vayu will result in reduced physiological activities of digestion and metabolism,

which in turn will result in metabolic disorders like diabetes mellitus. So, the primary focus

should be to work on improving the function of agni through samana and vyana vayu thereby

correcting any metabolic imbalance. This focus is achieved in two steps.

The first step is to increase the potency of the agni. The ailment diabetes mellitus happens

because of the reduced capability of this agni. Some of the techniques in yoga to improve the

potency of the agni are trikonasana (parsva and parivrtti), jatara parivrtti (parsva and

parivrtti) and ardha matsyendrasana. Long exhale and hold after exhale will improve the

function of the jataragni. This can be done either alone or combined with asana practice.

The second step is to maintain the balance of the agni. Once the agni is balanced, yoga

therapy should focus on the maintenance of its balance. Some of the techniques in yoga to

maintain this balance are tadaka mudra, ardha uttanasana, ardha utkatasana, mahamudra, etc,

Breathing techniques like samavritti pranayama, either practised alone or combined with

these asanas will maintain the balance.

Founder Director, Viniyoga Healing Foundation of India, Chennai

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FOCUS 2: TO WORK ON APANA:

According to yoga texts, apana is the region in the abdomen below the navel. Here, the

physical, physiological, psychological and deeper dross are collected. A bigger bulge in the

lower abdomen signifies a larger accumulation of waste products, ultimately leading to

diseases. Diabetes mellitus is a condition where the entire metabolic chain is deranged. As a

result, many metabolic waste products get accumulated in various parts of the body, more

particularly in the apana region. All the later complications of diabetes mellitus occur due to

this phenomenon.

Yoga firmly believes that everything is changeable. Even the accumulated metabolic waste

can be removed through proper yoga practice. There is a segment of prana, namely apana

vayu that is responsible for elimination of this accumulated waste. There are many

techniques in yoga which can improve the function of this vayu, thereby improving the

elimination of waste products. The techniques that can be used to work on the apana region

and reduce the dross are apanasana, urdhva prasrita padasana, utkatasana, viparita karani,

sarvangasana, etc. Long exhale and hold after exhale will increase the efficacy of these

asanas.

FOCUS 3: TO WORK ON AVOIDING FUTURE COMPLICATIONS:

Diabetes is one condition that can affect the entire constitution. If left unchecked, it

primarily affects the medium and small sized blood vessels and through this affliction, it

affects the heart, brain, nerves, eyes, kidneys, bowel, bladder and feet. So, the focus of yoga

therapy should also include techniques that will help to prevent these complications. Even if

any of the above systems are already affected, then there are suitable techniques in yoga

therapy to deal with the situation accordingly.

For example, in peripheral neuropathy condition, apanasana to urdhva prasrita padasana,

supta baddha konasana, akuncanasana, dhanurasana, and so on can be applied with suitable

modifications. To improve the coronary arterial perfusion, the techniques that open the chest

region thereby improving the prana function can be applied. For example, tadasana,

virabhadrasana, gentle standing and lying twists, and so on. Rechaka pranayama and

langhana type of chanting will also help.

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AN INNOVATIVE THERAPEUTIC APPROACH TOWARDS

DIABETES

Dr. PRAKASH CHINTAMANI MALSHE MD 1

Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, disordered

lipids and the attendant long-term complications. At its core are two abnormalities; a

disordered function of pancreatic beta cells resulting in a delayed and sometimes

inadequate insulin secretion and insulin resistance.

It is now well known that the insulin resistance is associated with obesity and it is still

debated which is primary. The insulin deficiency is not absolute and about one third of

diabetics have plasma insulin levels above the average.

As per our experience, Yoga can work much better for the primary prevention of the

disease rather than when once the disease has developed.

The four major concerns which can be addressed by yoga are as under:

1. Obesity reduction:

a. Mitahara: This is a fundamental principle of yoga. The corresponding physiological

principle is that nature has kept a great reserve everywhere. Therefore the appetite has

been adjusted to a much higher level as compared to the need of the body. We can

reduce the diet by half or even one-fourth of the felt appetite without losing a single

kilo. Most of us have been eating much more than our requirement and for years

together. Mitahara has been well defined by the yogic texts as filling of the stomach

to its half. I suggest my patients and yoga students the following way: Measure your

diet- on any average day, eat to your satisfaction, and side-by-side go on adding the

same amount to another empty plate. After you finish eating, measure the quantity of

food you have eaten. You may even be surprised looking at the quantity. Now

onwards, consume only half of this. This reduces the caloric intake.

Antar Prakash Centre for Yoga, SF 19, 20 Surya Complex, Ranipur Mode, Haridwar 249407.

Mob +919412073252, e-mail: [email protected]

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mailto:[email protected]


b. A weekly fast: Inducer of hormone-sensitive lipase (HSL). In yoga, the second limb

is niyama, and tapa is one of the five niyamas. The simplest tapa for a householder is

to observe one-day-a-week fast. It is a general principle of physiology that whatever

organs/systems/biochemical pathways we use are maintained in good function.

Whatever we don’t use goes into atrophy. Therefore, there is reason to believe that

those who never fast, lose their HSL. This explains their difficulty in fasting.

However, it is common observation that those who keep a regular weekly fast can

tolerate it much better. This may be because their enzyme is in an induced state. The

knowledge of physiology tells us that enzyme induction is detectable within 5 days

and goes on till several weeks. Therefore when one starts observing a weekly fast, the

sense of general weakness, ‘sunkenness’ etc all lasts for only 3-4 weeks. People

should be given this explanation and encouraged to observe one weekly fast. In order

to be really effective the fast should be observed taking only water and must be

continued beyond 24 hours. It is then only that lipolysis starts. A clinical indicator is

appearance of acetone in urine, which can be detected using simple dipsticks. This

ensures that HSL has acted. Periodic Fasting for such duration should be

recommended to keep the HSL in induced state. To the obese patients, this serves as a

key which can be operated at will as many times a week as required to lose desired

weight.

c. Inverted asanas for 15-20 minutes: Atrial nariuretic peptide (ANP) releasers. The

above mentioned HSL is acted upon by several hormones like thyroxine, adrenaline

and glucagon. Recently, ANP has been found to do the same. That means anything

that fills up and stretches the atria and stimulates release of ANP can be used for

obesity. In yoga there are several asanas which invert the trunk and in this way cause

increased atrial filling. They include shirshasana and sarvangasana and for those

who are unable to do these, the method of using a hick rope hanging from the ceiling

as advised by Shri BKS Iyengar should be used.

d. Suryanamaskara: As described in the booklet ‘Drink Air- Stay fit’ it appears to be a

series of manouvres designed to fill the intestines with air. With addition of kaki-

mudra at the specified steps wherever the yogi becomes upright, air is sucked into the

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stomach through the esophagus. Air distension of the gut is enough to create some

satiety which makes it easy to stay without food for a day-long. There is reason to

believe that this satiety is brought about by the release of GLP-1 which is a well

known intestinal satiety-peptide and has multitude of functions. In case of difficulty

in drinking air by Kaki Mudra, one can use Malshe’s puncured straw technique of

drinking air also described in the booklet mentioned above.

2. Reduction of cholesterol:

a. Why the body synthesizes cholesterol? It has been studied that while our diet

contains only 300 mg of cholesterol, about 1100 mg is excreted in the stool on a daily

basis. All this cholesterol comes from the liver where it is synthesized and excreted in

the stool. The purpose seems to be to prevent GI mucosal damage by enzymes,

especially lipolytic and proteolytic ones. If we do not have digestive enzymes, we do

not need cholesterol to protect our gut mucosa. So take predigested diet.

b. The protein myth: why do we require proteins in the diet? What for?

It is a myth that we require to have protein in our diet. The fact is we require amino

acids. These we require to build various structural and functional proteins which have

different half lives. The proteins synthesized once do not get destroyed quickly. Small

quantities of keratin are be synthesized everyday for maintenance of the skin, hair and

nails etc. Structural proteins like collagen once formed stay almost for the lifetime.

The muscle proteins are quite stable and do not have a large turnover. The plasma

proteins have a half life of about 2 months. Haemoglobin has a life of 4 months.

There is only one class of proteins that requires being synthesized everyday and the

whole quantity is destroyed the same day. These are the digestive enzymes secreted in

the gut- the salivary and pancreatic amylase, pepsin, trypsin, chymotrypsin, lipase,

and the host of different saccharidases and peptidases. Studies have shown that an

average person secretes about 60 grams of digestive enzymes in the gut. These can

not be reabsorbed as such and have to be broken down themselves into constituent

amino acids. This way the maximum turnover of amino acids is for synthesis of

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digestive proteins. If we do not need to digest, we do not need to secrete digestive

enzymes; so why not take predigested diet.

c. In praise of fruit diet: You must have seen big chunks of building material when

some old structure is demolished. Every chunk contains hundreds of bricks and a lot

of cement and sand. Would you use these chunks to build a new house or rather buy

new bricks? Obviously buying new bricks saves a lot of labour of first breaking the

chunks and separating the bricks. Moreover, in the process, many a bricks will be

broken and will be unsuitable for use. But in terms of food we do the same. Mostly

dietary proteins are those synthesized by the plants or animals for their use. First we

have to break them down into the component amino acids. Fruits contain lots of

amino acids. Some of their sourness and sweetness is due to this. Fruits also contain

absorbable sugars other than glucose which do not require insulin for their entry into

cells. In addition, one gets electrolytes, vitamins and fibre from them.

e. Activation of beta cells:

a. Air - filling maneuvers as described above. Air distension of the gut produces

satiety which is likely to be mediated by some satiety peptide. It can be Glucagone-

like-peptide-1 (GLP-1) which is a known incretin and is also known to have anti

apoptotic and beta cell stimulating action. Hypoxia stimulates proliferation of various

kinds of cells in the body and can help migration of stem cells from other locations

like bone marrow.

b. Methods to produce brief, intermittent hypoxia: As described elsewhere, several

yogic practices like bahya kumbhaka, nishshesha rechaka, nauli and agnisara lead to

brief hypoxia. Some asanas such as yogamudra and pawanmuktasana are also

conducive to hypoxia.

c. A one-day-a-week fast also increases survival of beta cells. Adipose cells, when

saturated with fat secrete more of leptin and a number of ‘Pro-inflammatory’

cytokines. These lead to insulin resistance in the peripheral tissues. Some of these

also deliver apoptotic signals to beta cells of the islets. No wonder, then, that a full

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20% of the obese become diabetics. On the days of fasting, the adipose cells secrete

much less of these chemicals, while the secretion of adiponectin increases.

Adiponectin has anti-apoptotic, regenerative and proliferative effect on beta cells. In

addition, on the day of fast, secretion of glucocorticoids is doubled. This can

neutralize the effect of the pro-inflammatory cytokines, (without increase in blood

glucose or blood pressure, as the individual is fasting). Therefore there is reason to

believe that a periodic fast will go a long way in preventing diabetes in the obese. I

have proposed a simple hypothesis, that a one-day fast postpones the onset of type-2

diabetes by 6 days. This way, a non-diabetic person can stay away from diabetes by

simply observing a one-day-a-week fast. Those with established diabetes who are still

obese can undertake even 2-day-a-week fast, of course taking precautions to avoid

hypoglycemia. It may require closer monitoring of blood glucose on the day of fast, a

reduction of doses in hypoglycemic drugs or changing from sulphonylureas to

metformin.

4. Prevention of vascular complications:

a. Hypoxia is an inducer of nitric oxide synthase (NOS). So any of the methods

described above to produce brief, intermittent hypoxia is suitable for treating vascular

complications. Generation of nitric oxide is beneficial in hypertension, coronary

artery disease and erectile dysfunction.

b. Asanas activate peripheral vessels and nerves and have an effect due to remote

ischemic preconditioning.

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Proc Ntl Workshop-cum- Seminar on Yoga & Diabetes

ROLE OF ASANA-PRANAYAMA IN DIABETES

Dr MANOJ NAIK MD1

Diabetes mellitus, a pandemic by now is affecting and afflicting people around the world

irrespective of race, religion, sex, class, and living standard. The number of patients and the

projected complications are mindboggling in their enormity and strenuous on national health

systems. The loss and pain caused by morbid chronic complications resulting from diabetes,

early mortality and loss of productivity is incalculable.

With the advancement in science and technology, several new medicines and insights into the

causes of diabetes and its complications have been discovered but then all these advances are

unable to fully control the pandemic. Its incidence has risen enormously. Hitherto considered

a disease of rich, it is now striking the poor and rural communities in developing countries.

A large contribution to the rising incidence of diabetes is from obesity, sedentary lifestyle,

and over-eating, especially too much junk food. These form the basis of lifestyle disorders.

Under such a dismal scenario, in order to tackle this disease, collaborative efforts are required

between various allied and alternative branches of modern science.

As per medical science, the human body comprises several systems: respiratory, digestive,

cardiovascular, genitourinary, nervous and musculo-skeletal system to name a few. Diabetes

is a disease afflicting the pancreas, and also the liver, intestines and the muscles in particular,

leading to deficiency of insulin secretion or its action or both.

In recent years, much research has turned focus on whether the power of yoga can be

harnessed to effectively address the pandemic of diabetes on three levels:

1. To keep a healthy human being from getting diabetes

2. To prevent a person with pre-diabetes from progressing to type 2 diabetes and

3. To help a diabetic avoid developing further complications from the disease.

Yoga, an ancient philosophy, science and art deals with human life, sufferings and the means

to eradicate them to attain emancipation. It is a universal subject and can be practised by all.

1 Consultant physician and Yoga Expert, Iyengar Yogashraya, Mumbai

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YOGA AND ITS EIGHT LIMBS

It is also called ashtanga yoga i.e yoga of eight limbs or petals and they are:

1. Yama (universal morals) covering ahimsa, satya, asteya, brahmacharya, aparigraha

2. Niyama (individual observances) are shaucha, santosha, tapa, svadhyaya and iswara

pranidhana

3. Asanas (postures): The numerous positions of the body which we are familiar with

4. Pranayama: regulation of life force (prana) with the use of breath

5. Pratyahara: withdrawal of senses from objects of pleasure

6. Dharana: focusing attention on a single point or locus (concentration)

7. Dhyana: maintaining this attention uninterruptedly (meditation) and

8. Samadhi: After a period of dhyana (meditation) the distinction between the subject

(individual) and the object (being meditated upon) is lost and both appear as one. This

is samadhi.

Yama and niyama are to be observed and not preached. pratyadhara, dharana, dhyana and

samadhi are advanced practices that are developed after years of training. Thus, one can start

with asanas followed by pranayama.

YOGIC CONCEPT OF EMBODIMENT

According to yogic science humans are made up of 'purusha' (soul) and 'prakriti (matter). the

latter is made up of several principles as given below.

The Yoga philosophy has studied the body comprising the following principles:

1. Chitta, manas, buddhi and ahamkara

2. Panchamahabhutas, the earth, water, air, fire and ether (space)

3. Panchatanmatras: shabda (sound), sparsha (touch), roopa (form), rasa(taste) and

gandha (smell)

4. Five sense organs: eyes, ears, nose, tongue, and skin

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5. Five motor organs: karmendriyas: two arms, two legs, organs of speech, genitals and

excretory organs.

It also has five layers or koshas that are:

1. Annamaya kosha (musculoskeletal body)

2. Pranamaya kosha (organic body - consists of various vital organs, heart, liver, spleen,

pancreas, kidney, etc.)

3. Manomaya kosha (mental body)

4. Vijnanamaya kosha (body of intelligence)

5. Anandamaya kosha (body of bliss)

Hence as per yogic science diabetes mellitus is a disorder of pranamaya kosha (organic body).

The function of yoga and especially asanas (postures) is to penetrate all these sheaths and

enhance the function of all these organs to ultimately conquer them. The annamaya kosha

(anatomical body) is used to exercise the pranamaya kosha (organic body) so that the vital

energy reaches these organs, keeping them in good shape. This action (organic exercise) is

unique only to asanas and no other form of exercises. These asanas churn, squeeze, massage,

compress and rotate the organs thereby improving the blood circulation and thus keeping

them healthy.

ASANAS AND DIABETES

Asanas mean a seat or posture. They represent the third limb of ashtanga yoga. According to

Shiva Samhita, there are eighty four lakh asanas that have been evolved by our great sages

and rishis for the benefit of the mankind. To an onlooker, asanas may look like physical

exercises, gymnastics or even acrobatics. However, the deeper, inner and higher effects are

realised and felt only by the practitioner. The higher effects can be experienced by the

practicing sadhaka, in correctly done asanas. Correct effects come from precise, accurate

placements of the body parts. Incorrect placements can yield wrong effects too. In fact, asanas

are an experimental science. The yogis have used the body as a means and tool to study nature

or prakriti. The yogis have used their own bodies to study and assess nature assuming shapes

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of various objects (e.g. trikonasana - triangle pose), animals (e.g. makara asana - crocodile

pose), vegetation (e.g. vrksasana - tree pose), birds (e.g. kapotasana - pigeon pose), and gods.

Asanas initially develop a strong, fit body which is used for further spiritual development. Its

ultimate effect is soul realization and abolition of dualities. For a yogi, asanas are prayers and

meditation.

Yogacharya BKS Iyengar, the great modern living legend in the field of yoga, has worked and

developed the universally applicable limbs of yoga - the asanas and pranayama. His tapasya

of 75 years and realization of the depths of these are the basis of this article. Seemingly

difficult or near impossible asanas are brought within the range of common man by use of

simple objects called props. Patients are able to do precise, accurate poses with these aids and

obtain their benefits. Guruji, as BKS Iyengar is known, has explained numerous benefits of

asanas based on his comprehensive subjective experiences. Asanas are multifaceted and they

render us holistic health. This includes physical, organic, mental, ethical, moral, intellectual,

emotional and spiritual health.

ASANAS HELPFUL FOR DIABETICS

Modern science has several drugs in its therapeutic armamentarium. These include

sulfonylureas, biguanides, glitazones, alpha-glucosidase inhibitors, DPP-4 inhibitors and

insulin. They have been studied and developed in laboratories and experimented on animals

(experimental physiology and pharmacology). After a lot of research, drugs were tested and

then finally brought into clinical practice.

A similar approach is used for therapeutic methodology in asana practice by Guruji. Several

asana have been developed, modified or altered to suit diabetics. However, these have not

been tested on laboratories or animals. He has worked them using his own body as an

experimental animal or guinea pig. This intense subjective research has shown the effects of

asanas which are given below.

Asanas work comprehensively on all principles of prakriti and all sheaths (koshas) of body to

ultimately conquer prakriti. The vital energy or life is made to flow all over the body to keep

all parts healthy. The anatomical body (annamaya kosha) is used to exercise the organic body

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(pranamaya kosha). The vital energy reaches these organs and keeps them in good shape.

Guruji calls these effects as organic exercises. All forms of exercises, sports, gym and

activities have effects mainly on muscles, joints and bone, while they have negligible effects

on the organs or systems. This action is unique only to asanas. They use various skeletal parts

to exercise these organs. These organs are attached loosely to the posterior abdominal wall

and by themselves cannot do any action. In various postures these organs are compressed,

squeezed, churned, rotated, extended and massaged. This increases their blood supply and

enhances their function.

Diabetes is a disease affecting pancreas. Other organs important in glucose metabolism are

liver, intestines, muscles and fat (especially central fat). According to yoga, diabetes is a

disease of pranamaya kosha affecting the organs. These are tackled in a way shown below in

various illustrations of asanas. They not only affect the organs but also help in the following

ways: body remains healthy. Stiffness (e.g frozen shoulder, common with diabetics) is

avoided. Mind is fresh. Appetite regulation is more spontaneous. Proper foot shape and

arches are maintained (which has great preventive role for diabetic foot injuries).

Cardiovascular health can also be maintained by asanas. Certain asanas work on the renal

system in an enhanced way, this result in proper bladder control. Asanas also benefit the

kidneys.

Hypertension and ischemic heart disease often accompany diabetes. Also, long term

complications of diabetes affects heart, kidney and virtually every organ. Depression and low

self-esteem occurs in some patients due to chronic illness. Often some lasting irreversible

complications also cause a similar low feeling. Here, asanas work profoundly on mental

sheath (manomaya kosha) and eliminate such feelings.

Several diabetic complications may be irreversible and crippling. Here too, yoga philosophy

helps. It says heyam duhkhamanagatam: Those sufferings or diseases which can't be avoided

must be endured as per yoga philosophy. Yoga fortifies the body and mind to endure the

sufferings which cannot be avoided. Medicines play a role only after the patient develops

diabetes, but asanas work on everybody well before the onset of diabetes. Post diabetes they

help the failing pancreas by organic exercise. Effects of diabetes on other organ system is also

minimized or delayed with regular asana practice. Enhanced mood and change of personal

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outlook result in positive mental frame, wherein a patient is confident of controlling his

disease. Few asanas, beneficial for diabetics are given below:

Virasana (warrior pose) Jathara parivartanasana (abdominal twist)

Sputa virasana (supine warrior pose) Urdhwa mukha shwanasana (upward facing

dog pose)

Paschimottanasana (left body stretch) Sirsasana (head stand)

Marichyasana - 3 Sarvangasana (complete body pose)

Ardha matsyendrasana (half fish pose) Viparita dandasana (reverse prostration)

Navasana (boat pose) Urdhwa dhanurasana (bow pose)

Ardha navasana (half boat pose) Setubandha sarvangasana (bridge stand)

Paripurna navasana (full boat pose) Urdhwa pranita padasana (leg lift)

PRANAYAMA

Pranayama (prana life force, ayama: expansion) means expansion of the life force and is done

with the help of the breath, but life force and breath are separate. In pranayama the life force

is accessed using breath as a tool. A sharp, sensitive mind to observe subtle movements of

breath is also a prerequisite for Pranayama. Asana practices for up to a period of six months to

a year should make an individual ripe for starting pranayama practices. No sooner does one

achieve reasonable proficiency in the above asanas, ujjayi pranayama, vilome pranayama and

pratilome pranayama are next recommended under the guidance of a competent teacher. It is

introduced in savasana with spine supported by bolster and while sitting. The components of

breathing are: puraka (inhalation), antara kumbhaka (internal retention after inhalation),

rechaka (exhalation) and bahya kumbhaka (external retention after exhalation). Ujjayi

pranayama, viloma pranayama and pratiloma pranayama are recommended for diabetics.

Customarily, walking for 45 minutes or so, five times a week is recommended as one of the

most important practice by many diabetic associations. But this rule ignores a basic limitation:

much too often, diabetics suffer from heart ailments too, which may not permit walking for

long. Osteoarthritis of knee and hip may also hinder this practice. Also, that retinopathy

(reduced vision), diabetic foot (neuropathy, peripheral vascular disease, ulcers, calluses, etc.)

may also restrict walking. For such people asanas are the best answers to all their problems.

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WORDS OF CAUTION

Yogic science says that proficiency in the practice of asanas is necessary and in particular

before initiating pranayamic practices. If not done correctly it can cause harm to the sadhaka

(one who is performing pranayama). The prana therefore needs to be controlled very slowly

and cautiously through the breath. Often, people start pranayamic practices directly without

first practicing the asanas. They may end up practicing yoga in a haphazard manner.

Pranayama generates tremendous vital energy and needs a network for its correct distribution

and to prevent dissipation, which is done by bandhas. Asanas create correct nadis (channels of

energy) for distribution of this energy but if the prana flow is erratic or forceful, it can injure

the nadis and the nervous system. This explanation should be enough to prevent the readers

from looking at few pranayama practices as an answer for all ills including diabetes.

Incorrectly done pranayama can have side effects. People tend to view pranayama as a

panacea for all ills, which is medically wrong and against the principles of yoga.

Why is this caution necessary? Breathing is dependent on the rib cage (ribs, thoracic, spine,

sternum and their articulation), lungs and respiratory muscles. For efficient and deep

breathing necessary for pranayama, these joints of the rib cage have to be kept mobile. Lungs

need to be elastic and the respiratory muscles efficient, which is done with various asanas.

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YOGA PRACTICES FOR PREVENTION AND MANAGEMENT OF

DIABETES MELLITUS

Yogacharya Dr ANANDA BALAYOGI BHAVANANI1

Yoga is an integrated way of life in which awareness and consciousness play a great part in

guiding our spiritual evolution through life in the social system itself by understanding that

"yoga is the science and art of right-use-ness of body, emotions and mind".

Yoga can play a major role in prevention and control of diabetes mellitus that is turning out

to be one of the major killers of the modern world. Yoga is of special value to those suffering

from type-2 or non insulin dependent diabetes as it helps to sensitize the body cells to the

insulin and helps the body fight the hyperglycemic state in an effective manner. The healthy

exercise and weight loss produced by yoga as well as the dietary aspects when followed

religiously and regularly can help prevent and control this disorder to a great extent.

POSTULATED MECHANISMS BY WHICH YOGA CAN HELP REDUCE RISK FOR TYPE 2

DIABETES MELLITUS AND ITS COMPLICATIONS*

*Innes KE, Vincent HK. The Influence of yoga-based programs on risk profiles in adults with type 2

diabetes mellitus: A systematic review. eCAM 2007; 4: 469-86.

Programme Co-ordinator ACYTER, JIPMER and Chairman ICYER at Ananda Ashram,

Pondicherry. www.icyer.com and www.rishiculture.org

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YOGA THERAPY FOR DIABETES:

1. Exercise: It is important to use up the excess blood sugar by regular exercise. Walk

whenever possible and skipping or swimming are good adjuvant to yoga therapy.

2. Diet:

Regular small meals with complex carbohydrates.

Avoid refined foodstuffs and junk food.

Take lots of green vegetable salads, bitter gourd and neem.

Maintain good hydration.

3. Suryanamaskar: Performance of three to six rounds of suryanamaskar helps to

utilize the excess glucose and also to help speed up metabolism and weight loss.

4. Asanas:

Twisting poses:

Standing: Trikonasana, ardhakati chakrasana

Sitting: Vakrasana, ardha matsyendrasana, bharadwajasana,

shashangasana

Reclining: Jataraparivartansana

Abdominal pressure poses:

Sitting: Utkatasana, janushirasasana, pashchimottanasana, navasana,

yogamudrasana, stambam asana and mayurasana.

Reclining: Pavanamuktasana, dhanurasana, bhujangasana,

shalabhasana, noukasana

Topsy turvy: Sarvangasana, janusirasa in sarvangasana, karnapidasana and

halasana

5. Pranayamas:

Vibhaga and pranava pranayamas with special emphasis on adam pranayama

and AAA sound.

Bhastrika pranayama to utilize the blood glucose.

Savitri pranayama, chandra anuloma pranayama, nadi shuddhi pranayama for

stress reduction

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6. Kriyas: Kunjal, nauli, kapalabhati, agnisara, shankha prakshalana

7. Mudras and Bandhas:

Viparita karani and mahamudra.

Uddiyana, moola and jalandhara bandhas.

8. Relaxation: Shavasana, makarasana and kayakriya.

9. Dharana: Mandala dharana on all chakras with emphasis on manipura chakra and the

sound of RAM (RUNG)

BASIC WARMING UP PRACTICES

Jattis are basic movements of the body parts that help to release pent up tension in those

parts. They increase circulation to the part and also the flow of pranic energy is increased due

to the movements. A few of these practices will be described now.

Take up a comfortable standing position such as the samasthitiasana. Stand on one leg and

shake the other leg. Repeat on the other side and then alternate a few times between right and

left. Stand on both legs and start to shake your hand one at a time. Alternate between right

and left hand a few times and then start to shake both hands, at the same time. Shake your

hands and move them up, down, to the left and to the right. Shake your hands all around you

in a circular movement. This helps to energize the Pranamaya kosha, our energy sheath or

subtle body. Come back to the standing position.

Open the legs two feet apart and keep the hands on the hip. Move the torso in all four

directions clock-wise and anti clock-wise in a grinding action. Then do it in a continuous

manner. Bend forward and perform some toe touching with a bouncing action. Bounce to the

front, and then move to your left. Move to your right and then come back to the front. Come

back to the standing position.

Spread your feet a bit and lift both your arms to the side. Start to twist your torso from side to

side a few times. Feel the stretch in your hip region and back. Come back to the standing

position and relax with deep breathing for some time.

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Sit down with both legs stretched out in front of you. Draw your right knee up to your chest

and then kick out with a whooshing sound. Perform the same action on the left side. Continue

to alternate legs for some time. Draw up both your knees and do the same action with a

whooshing sound as you release the feet. Relax with your feet stretched out in front.

SURYA NAMASKAR: Rishikesh suryanamaskar, the yogic sun salutation is a series of

twelve physical postures. These alternating backward and forward bending postures flex and

stretch the spinal column through their maximum range giving a profound stretch to the

whole body. The basic breathing principle is to inhale during upward and backward bending

postures and exhale during forward bending postures.

Stand erect with your feet close together. Perform namaskarmudra by joining your palms

together in front of your chest. Breathe in and stretch your arms over your head into the

anjalimudra and then arch your back. Feel the healthy stretch in your whole body.

Breathe out and bend forward while keeping your arms and back in one line and as straight

as possible. Perform the padahastasana by bringing your head to your knees while keeping

your hands on either side of your feet.

Breathe in and extend your right leg back until it is as straight as possible and you are

balanced on your toes and hands. Your left leg should be bent with the sole flat on the

ground. Lift your head, bend back and open up your chest. This is ashwasanchalanasana, the

equestrian posture.

While breathing out bring your left leg back towards the right and keep the feet just a foot

apart with your heels flat to the ground. Simultaneously raise your buttocks and lower your

head between your arms, so that your body forms a triangle with the ground. This is

meruasana or mountain posture. While maintaining the posture, take a deep inhalation.

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While breathing out drop both knees to the ground and slowly slide the body down at an

angle and bring your chest and chin to the ground. Eight parts of your body namely your

toes, knees, chest, hands and chin should touch the ground while the buttocks are kept

up. Hold out your breath while performing this ashtangabhumisparsha, the eight limbed

prostration.

Breathe in and come into bhujangasana, the cobra posture. Focus your awareness at the base

of your spine and feel a healthy stretch in your back and neck.

Exhale and come back to the meruasana, the mountain posture. This strengthens the muscles

of the arms, legs and entire back.

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Inhale and bring your right leg forward in-between your hands while keeping your left leg in

its original position to perform the ashwasanchalanasana. Breathe out and bring your left foot

forward to come into the padahastasana.

Breathe in and come up and perform the anjalimudra and bend backward. Breathe out and

come back to the standing position while bringing your hands back to the chest in

namaskarmudra.

To perform the Rishikesh suryanamaskar on the opposite side perform the practice again

with a slight modification. To complete the other half the same movements are repeated

except that the left leg is brought back while performing the ashwasanchalana the first time.

The other postures such as meruasana, ashtangabhumisparsha and bhujangasana are done in

the same manner. When coming back to ashwasanchalana, the left foot is brought forward

and then padahasta is performed by joining right foot to the left before completing the

practice with the anjali mudra. Finally relax in samasthiti with deep breathing.

One full round consists of these 12 poses done twice in sequence. Practice 3 to 9 rounds

daily for maximum benefit. When the exercises are done little quickly the gain is more

physical and when they are done slowly with breath awareness the gain is more mental and

spiritual.

YOGA ASANAS

TALA KRIYA: The term, “tala” refers to a palmyra tree and you should try to

stretch yourself tall as that tree while performing this practice. Take up a

comfortable and stable samasthitiasana. Breathe in and lift both arms up over

your head until they are parallel to each other. Let the palms of both hands face

inward and then go up onto your toes and stretch up as high as possible. Hold

the breath and feel the healthy stretch along your whole body from toes to finger

tips.

Breathe out and relax your arms back to your sides while coming back to the flat

foot posture. Repeat the practice two more times at each session for maximum

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benefit. With practice the posture can be held for a longer time and normal breathing done

while holding the posture for 30 to 45 seconds.

HASTHAKONA KRIYA (Ardhakati chakrasana): Stand in steady samastithiasana with

your arms by your side. Breathe in and lift your right arm over your head. Try to extend the

arm over your head towards the left as far as possible without bending it. This gives a good

stretch to the entire right side of the body. Slowly breathe out and lower your arm back to

the side. Repeat it a few times.

Make sure that you lift your arm on the in breath and lower it on the

out breath. Perform the practice on the opposite side by lifting your

left arm over your head while breathing in. Extend it as far towards

the right as possible without bending it. Feel the excellent stretch on

the entire left side of your body. Lower your arm back to your side

while breathing out. Repeat the practice a few more times.

Hasthakona kriya helps to stretch and tone up the musculature of

the arms, shoulders and the para-spinal area in a way not done in

day-to-day life. This helps trigger the relaxation response in these tissues that are normally

tensed due to disuse, misuse and abuse. A sense of profound relaxation is obtained after the

practice of this activity.

TRIKONA ASANA: Stand in samasthitiasana. Place your feet two to three feet apart facing

forwards. Stretch your arms to the sides so that they are pulling the chest in opposite

directions. Turn your head and right foot to the right side and slowly bring your right hand

down to the right foot and place the palm of the right hand on the ground in front of the right

foot. Look up at the middle finger of the left hand. Let the

entire torso get a good twist and stretch. Hold the position for

30 seconds while performing regular breathing. Release and

come back up to the open arm position and then do on the

opposite side by placing your left hand down in front of the

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left foot. Hold the position for 30 seconds while performing deep breathing. When ready

come back up to samasthitiasana and relax with a few rounds of deep breathing.

VAKRA ASANA: Sit erect with your legs stretched out in the uttanasana. Bend your right

knee and place the right foot by the side of the left knee. Turn to your right and place your

right hand on the ground behind you to support your erect position. Bring your left arm round

the outer side of the right knee and catch hold of the right big toe. Turn your head and look

back over your right shoulder. The erect knee acts as a fulcrum for getting maximum twist of

the spine. Keep your torso as straight as possible. Hold the

posture for 30 seconds with soft breathing.

Release the posture and come back to the uttanasana. This

posture gives an excellent massage to the abdominal organs

and is very useful for those suffering from diabetes as well as

digestive disorders. It is also useful for neck and back

problems. Repeat the practice on the opposite side in a similar manner. Hold the posture for

30 seconds with soft breathing. Release the posture and come back to the uttanasana and

relax with deep breathing for some time.

ARDHA MATSYENDRA ASANA: Sit erect with both legs stretched out in front and your

palms gently pressing on the ground by your sides in uttanasana. Fold your right knee and

place the heel tight in against the perineum. Place your left foot by the side of your right

thigh by crossing it over the knee. Bring your right arm round the outer side of the left knee

passing between the chest and the knee and catch hold of the left big toe. Your right shoulder

blade rests on the outer side of your left knee.

Take your left hand round your back and try to get a grip on

your right thigh. Look back over your left shoulder. The

erect knee acts as a fulcrum for getting maximum twist of

the spine. Keep your trunk vertical. Hold the posture for 30

seconds with soft breathing. Repeat on the opposite side and

hold the posture for 30 seconds with soft breathing. When

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you are ready slowly release the posture and come back to the uttanasana.

CHATUSH PADA ASANA AND VYAGRAHA PRANAYAMA: Take up the

chatushpadasana with your weight evenly distributed between your hands and knees. Start

breathing in and out each for a count of six. While breathing in slowly lift your head and arch

your back downwards. Then breathe out slowly and lower your head while arching your back

upwards. Breathe in while lifting your head and arch your back down.

Breathe out while lowering your head

and arching your back up. Repeat this

excellent practice at least nine times at

each session. Vyagraha pranayama

helps us to utilize all sections of our

lungs in a balanced and controlled

manner thus energizing the whole body with healing pranic energy. When ready, slowly

relax back to vajrasana for a period of quiet contemplation.

BHUJANGINI MUDRA: To perform the cobra gesture, take up unmukhasana which is a

prone position with your entire body in a straight line. In this technique the emphasis is on

breathing pattern and production of a mighty hissing sound through the clenched teeth.

Slowly bring your arms forward and keep your palms on the ground alongside your

shoulders. Take in a deep breath. While making a mighty hissing sound, flare back into the

bhujangasana. Slowly relax back onto the floor while breathing in and then again flare back

with a mighty hiss. Repeat this Mudra at least three to six times at each session. This

technique helps release the pent up stress that accumulates in our system from our daily life

and provides great emotional and mental

relief.

It is an excellent stress-buster and is a must

for all in this day and age. After

completing the practice come back down to

the face prone pose. Place your arms

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alongside your body and turn your head to the side. Relax for a few minutes and let the

benefit of this mudra seep into each and every cell of your body.

PAWAN MUKTA ASANA: Lie down in a

comfortably in shavasana and start to breathe in

and out for an equal count of six or eight. To

perform the single legged ekapadapawan

muktasana, bend and lift your right knee while

breathing in and simultaneously also lift your head off the ground. Catch hold of your knee

with your arms and try to touch your knee to your forehead. Hold the position for a few

seconds and then while breathing out slowly release the position and lower your head while

at the same time bringing your foot back to the ground.

Repeat this at least two more times to complete a set of three rounds of the practice. Relax a

few seconds in the shavasana and then perform the practice on the left side. Relax in

shavasana for a few minutes with deep and rhythmic breathing while concentrating on your

abdominal area that will help to relax you further.

To perform the double legged dwipadapawanmukta

asana, bend and lift both your knees while breathing in.

Bring them as close to your forehead as possible while

simultaneously raising your head to meet the knees.

Hold for a few seconds and then while breathing out,

lower your head and simultaneously bring your feet

back to the ground. Repeat this two more times to complete a set of three rounds at each

session. Relax in shavasana for a few minutes with deep and rhythmic breathing while

concentrating on your abdominal area. This will help you to relax even further as the

emotional tensions tend to tighten up the abdominal area leading to a feeling of “butterflies in

the stomach”.

EKA PADA UTTANPADA ASANA: From shavasana

lift your right leg up towards the sky on the in breath.

Try not to bend the knee if possible. On the out breath

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lower the leg back to the ground. Use a breath cycle of in and out for a count of six or eight.

Repeat this two more times. Perform the same practice on the left side. Repeat this two more

times. After performing the practice at least three times on each side relax in shavasana with

deep breathing.

DWI PADA UTTANPADA ASANA: From shavasana lift both legs

up towards the sky on the in breath. Try not to bend the knees if

possible. On the out breath lower the legs back to the ground. Use a

breath cycle of in and out for a count of six or eight. Repeat this two

more times and then relax in shavasana with deep breathing. Those

who have back problems should not do straight leg lifting and should

do it with bent knees instead to avoid strain on the back.

SARVANGA ASANA: Lie down in shavasana. Breathe in and lift both legs at a

time until you are in the dwipadauttanpadasana. Continue the upward motion

and lift your back off the ground using both arms to support the lower back.

Keep your trunk and legs in a straight line by supporting the entire trunk on the

shoulders. Breathe in a shallow manner while concentrating on the healthy

pressure at the throat region.Release the posture after 10 to 15 seconds and

while breathing out slowly come back to the Shava Asana. Roll your head

from side to side to ease away any pressure that may have accumulated in the

neck. After a short relaxation, repeat the practice two more times.

VIPARITA KARANI: Viparitakarani is the shoulder stand-like mudra where the weight of

the body is supported by the elbows while the hands are placed against the pelvic girdle.

From the supine shavasana slowly lift both your legs up as if performing sarvangasana.

However the weight of your body should be balanced on your elbows and arms and not on

your shoulders. Hold the posture in a comfortable manner and then start to perform the

incomplete and complete actions of this mudra.

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Perform the incomplete action by taking a deep inhalation and bringing your straightened

legs towards your head so that your body makes an acute angle. Then perform the completed

action by pushing your legs away while exhaling the breath. Make sure that your feet are

extended in a rigid position making an obtuse angle.

Breathe in bringing your feet towards your head 1-2-3-4-5-6. Breathe out pushing your feet

away 1-2-3-4-5-6. Continue the practice for a minimum of

three to nine rounds of this alternation between the

incomplete and complete postures with the breath cycle at

every session.

This mudra promotes a healthy metabolic function by

stimulating the pancreas and the uptake of insulin by cells of

the body. It is highly recommended for the prevention,

control and possible cure of conditions such as diabetes

mellitus and imbalances of the thyroid gland. When ready

slowly bring your legs down to the ground in a phased

manner and enjoy a quiet period of relaxation in shavasana.

SHAVASANA WITH SAVITRI PRANAYAMA: Lie supine on the ground with your head

preferably to the north enabling your body to be in alignment with the earth’s

electromagnetic field. Make sure that your head and body are in a straight line while hands

are kept relaxed by the side with palms facing upwards. Bring your feet together and let

forefeet fall away into a ‘v’ shape with heels as close together as possible.

Start to consciously watch your breath by letting your awareness settle in the abdominal area.

Feel the abdominal movements as your abdomen rises as you breathe in and falls as you

breathe out. After a few rounds of this practice, slowly let your awareness settle at the tip of

your nose. Feel the cool inspired air flowing into your nostrils as you breathe in and become

aware of the warm expired air flowing out of the nostrils when you breathe out. Consciously

regulate your breath so that the duration of the incoming and outgoing breathes are equal.

The inspiration and expiration can be for a count of 4 or 6 initially and then with practice

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increased to a count of 8 or 10. Perform at least nine rounds of this conscious deep breathing

and enjoy the relaxed sensation that spreads throughout your body.

The relaxation in shavasana can be further deepened by utilizing savitri pranayama to relax

and rejuvenate your body, emotions and mind. Breathe in through your nose for a count of 6.

Hold in the breath for a count of 3. Breathe out through your nose for a count of 6. Finally

hold the breath out for a count of

3. This is one round. Perform at

least 9 rounds of this combination

practice that heightens the relaxation to a very deep level. Make sure that you are breathing

in and out through both nostrils and that you are using the complete yogic breathing.

After performing shavasana for 10 to 15 minutes, slowly start to move your fingers and toes.

Perform conscious stretching and make a smooth transition from the relaxed to the active

state. Lift your left arm over your head and turn over to your left side. Continue the turning

action until you come into the face-prone posture. Perform makarasana by placing your right

hand on the left while the left is placed palm down on the ground in front of you. Keep your

forehead or chin on your right hand while keeping your legs a foot apart.

Bring your hands forward near your shoulders and push yourself back into the bhujangasana.

Continue the back bending movement and go into the four footed chatushpadasana. Relax

into the shashangasana with your arms stretched out in front and then finally come back to

the vajrasana. With your palms on your thighs sit quietly for some time and enjoy the effects

of the deep relaxation that has spread to every part of your body.

SPANDA – NISHPANDA KRIYA: This practice is done from shavasana using the yogic

concept of spanda-nishpanda, which means the coupling of tension and relaxation. We

consciously tense different parts of our body as much as possible and then relax them to the

maximum in a step-by-step manner. This produces a better relaxation response than the mere

attempt to relax without putting in the initial effort of tension.

Lie down in a comfortable supine shavasana with your entire body in a straight line. After a

few seconds of relaxation in this position, start to tense your entire body part-by-part from

your toes up to the top of your head until every part of your body is as tense as possible.

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Hold this 100% tension state of spanda for a few seconds. Let all the muscles of your entire

body be as tense as possible.

At the peak of the tension, just ‘let go’ and immediately relax your entire body 100%. This is

the state of nishpanda. Enjoy this relaxed state and with conscious awareness continue to

watch your breath as it comes in and goes out of your nose.

Repeat this practice again by tensing up your entire musculoskeletal system to the state of

spanda and hold it for a few seconds. When ready let go completely and enjoy the nishpanda

state for a few minutes.

To complete the practice repeat the spanda – nishpanda kriya a third time by tensing up your

entire musculoskeletal system from your toes to the top of your head. Hold the complete

tension for a few seconds. When ready, let go completely and enjoy the complete relaxation

that ensures. Be aware of how all your muscles relax in this practice because the relaxation is

deepened when it is contrasted with tension. This practice is a boon for those suffering

psychosomatic, stress-induced and stress-aggravated disorders like hypertension, diabetes,

asthma, insomnia, peptic ulcers and bowel disorders.

MARMANASTHANAM KRIYA: The twenty-two sensitive parts of the body are known

by the collective Sanskrit term marmanasthanam. To concentrate upon these parts in a

particular order or to command these areas to relax in a particular way while concentrating,

gives a very satisfactory and deep relaxation that has been found by tested experiments to

give relief even to compulsive dreaming. This is an excellent Kriya to do at the end of a

strenuous session of asanas and pranayamas. The relaxation should be preceded by at least

nine rounds of savitri pranayama, the rhythmic breath, to create the proper atmosphere.

This technique can be done in two ways, one for relaxation the other for deep concentration.

For relaxation the technique is done from “feet to the head.” For deep concentration from

“head to feet.” While concentrating upon twenty-two body parts, each part is commanded

(by mind) “to relax” or a thought of peace or serenity” directed to the areas.

For relaxation, concentrate upon the (1) toes and command the toes to relax (2) feet (3) lower

legs to knees (4) upper legs to hips (5) buttocks (6) base of spine (7) pelvic area (8) abdomen

(9) chest and (10) shoulders. Now take your concentration down to the (11) fingers, and

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command the fingers to relax then (12) hands (13) lower arms to elbows (14) upper arms to

shoulders where your concentration joins with body concentration (15) throat (neck) (16)

around the mouth and chin (17) around the nose and cheeks (18) eyes (19) back around the

ears (20) back of the head (21) top of the head (22) cavernous plexus in the middle of the

forehead. All the while you should command “relaxation.”

Perform jyoti dharana and dhyana (concentration and meditation on the divine light) at the

bhrumadhya bindu (midpoint between the eyebrows). Visualize the divine jyoti to be having

the brilliance equal to 1000 suns but without the glare. Absorb yourself into this divine jyoti.

PRANAYAMA PRACTICES

PRANAVA PRANAYAMA: ‘Tasya vachakah pranavah’, the sacred sound of the divine is

the pranava says Maharishi Patanjali. This develops abdominal, thoracic and clavicular

regions of the lungs to their maximum capacity. Pranava pranayama has unlimited healing

potential and is useful in virtually all disorders. It brings about harmony of body, emotions

and mind and is an important part of Rishiculture ashtanga yoga tradition as taught by

Yogamaharishi Dr Swami Gitananda Giri Guru Maharaj.

Adham pranayama, the abdominal or lower chest breathing. Put

the fingers into the Chin Mudra with the index and thumb fingers

touching each other at the tips. Keep the other fingers straight and

united. Take a deep breath into the lower chest and abdominal

regions..1..2..3..4. Now let out the breath with the sound aaa…….

To perform thoracic or mid-chest breathing, the madhyam

pranayama, curl your fingers inward to form chinmaya mudra.

Take a deep breath into the mid chest and thoracic regions

1…2…3…4. Now breathe out with the sound ooo…….

Adyam pranayama is the clavicular or upper chest breathing and

utilizes adhi mudra. Clench your fists with your thumb in the

centre. Keep the adhi mudra on your thighs and breathe deeply

into upper chest and clavicular regions and then exhale with the

sound mmm…….

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Joining the earlier three parts of the breath in a complete yogic

breath is the fourth stage, known mahat yoga pranayama. Put the

adhi mudra with knuckles of your right and left hands touching in

front of the navel. This is now known as the Brahma Mudra. Take a

deep breath into the low 1…2…mid 3…4…and upper chest

5….6….regions. Now let the breath out with the sounds of aaa…ooo…mmm….

Relax and enjoy the feeling of potent healing energy flow through the entire body.

NASARGA MUKHA BHASTRIKA: Nasarga mukha bhastrika is a forceful expulsion of

the breath through the mouth that can accompany different movements to relieve our pent up

stress. Take up a comfortable standing position and then start to shake your hands as

vigorously as possible to help loosen the accumulated tensions of your daily life. Visualize

all the tensions that have accumulated in your wrist and elbow joints getting a good ‘shake

up’ by this action.

When you have got the tensions loosened up, take in a deep breath through your nose and

clench your fist as if catching hold of all your tensions and stress. Now with a powerful blast

through your mouth "whoosh" away all your accumulated tensions and stress as forcibly as

possible. Again shake your hands as fast as possible.

Breathe in and catch hold of the tension in your fist. Throw it all away with a blast. Make

sure that you are using your diaphragm muscle vigorously while blasting out the breath in

this practice.

Perform this practice 3, 6 or 9 times as necessary. After performing 3 to 9 rounds of this

practice, relax in the standing position and enjoy the feeling of relief that sweeps through

your arms as you relax with some deep breathing.

CHANDRA PRANAYAMA: Sit in vajrasana and perform nasarga

mudra with your right hand. Close your right nostril with your thumb.

Inhale slowly through your left nostril for a count of four. Now exhale

through the same left nostril for a count of eight.

Keep your right nostril closed throughout the duration of the practice.

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Repeat the chandra pranayama for a minimum of nine rounds at each session. Patients of

anxiety, hypertension, insomnia and other stressful conditions can benefit by practising this

Pranayama 27 times before breakfast, lunch, dinner and before going to bed at night.

BHRAMARI PRANAYAMA: Sit on the heels in the

vajrasana with the spine erect. Perform shanmukhi

mudra with the thumbs of the hands closing the

external auditory canal. The first two fingers are then

placed over the closed eyelids while the ring fingers

regulate the flow of air through the nostrils. The little

fingers are placed over the closed lips. This mudra

helps join together nerve energies of hands with facial and trigeminal nerves on the face.

Take a slow and deep breath in for six counts. Let out the breath very slowly while making a

sound in the nasal passages like the high-pitched sound of a female bee. This buzzing sound

is very much like the anuswarah sound of “mmm” of the pranava AUM. Repeat this at least

nine times. Bhramari is one of the swara pranayamas that stimulates and tones up nerve

centres. This helps relieve pitta conditions and rejuvenates the skin. It also creates a beautiful

voice. It is a contemplative prelude to nada yoga.

CONTEMPLATIVE PRACTICES

PRANA DHARANA OR BREATH AWARENESS: Sit in vajrasana or lie down in

shavasana. Begin to be aware of your breathing and how the air passes down from the

nostrils into the lungs and then back out the nostrils. Feel the abdominal movements as the

abdomen rises with the in breath and falls with the out breath. Let your awareness settle in

the abdomen. Feel the cool inspired air flowing into the nostrils and the warm expired air

flowing out of the nostrils. Let your awareness settle at the tip of the nose. Consciously

regulate the breath so that the ratio of inspiration: expiration is equal. It can be a 4, 6, 8 or 10

count. Perform nine rounds of this practice.

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MINDFULNESS BASED MEDITATION: One of the most productive of the many forms

of “quiet sitting”, popularly grouped under the heading of meditation is the mindfulness

based awareness of one’s thoughts. This is to be done without identifying with the thoughts

and without either justifying or condemning them. Take up a straight back sitting position

and sit facing to the North or East in the early morning. Keep your mind as placid as

possible, as this is the important feature of the early morning meditation. Breathe slowly and

rhythmically, but very quietly. Do not upset the peace. Hold your mind concentrated inside

your head at a point in line with the eyebrows. Relax. Don’t attempt to force visualization,

simply be alert and expectant. Presently, you will have the sensation of movement within the

head, as though watching a “ticker tape” of your thoughts. The thoughts will be in extreme

slow motion. Observe the thoughts. Don’t get emotionally involved with them, just watch

them. You will actually be able to see your thoughts, as well as hear them. Usually, the

thoughts are quite mundane, but benign. Simply observe them passively and dispassionately.

OM JAPA: Take up any meditative posture and start to perform the savitri pranayama in a 6

by 3 or 8 by 4 rhythm. Make an audible pranava OM in the bindu nadi. With japa-ajapa,

make silent intonation of the pranava OM, concentrating at this same point. Do not let the

mind waver away from either a conscious repetition of the mantra OM, as Japa, or as the

silent ajapa.

AJAPA JAPA: Take up any meditative posture and start to perform the savitri pranayama in

a 6 by 3 or 8 by 4 rhythm. As you breathe in listen to the sound of SAH made as the breath

enters your respiratory passages. As you breathe out listen to the sound of HUM that is made

as the breath leaves your respiratory passages. Concentrate on this ajapa japa of HAMSA

SOHAM in tune with the breath.

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EFFECT OF YOGA ON OXIDATIVE STRESS AND INFLAMMATION

IN TYPE 2 DIABETES

Dr PRABHA ADHIKARI MD1 and Dr SHREELAXMI V HEGDE PhD

2

Oxidative stress has been implicated as the root cause underlying the development of insulin

resistance, β-cell dysfunction, diabetes, and its associated clinical conditions like

atherosclerosis, microvascular complications, and neuropathy.

Inflammation plays a crucial intermediary role in the pathogenesis of diabetes.OST mediated

alterations of cytokine expression of IL-6 lead to inflammatory responses. Repeated

hyperglycemia due to insulin resistance aggravates the OST and cytokine mediated

inflammatory response which further worsens beta cell dysfunction.

Yoga has been found to be beneficial in reducing oxidative stress in type 2 diabetes, but there

is a lack of controlled trials to demonstrate the same.

We conducted a study on the effect of 3 month practice of yogasanas and pranayama on 123

type 2 diabetes patients who were stratified for complications such as microvascular,

macrovascular, neuropathy and no complications and allocated 60 to yoga group and 63 to

control group.

Three months yoga training included tadasana, padahastasana, vrikshasana, trikonasana,

parshvothanasana, vajrasana, vakrasana, gomukasana, paschimotasana, uttanapadasana,

pawanamuktasana, bhujangasana, shalabasana, dhanurasana, viparitakarani, sitkari and

bhramari pranayama, anuloma viloma, and shavasana poses.

In comparison with the control group yoga intervention resulted in significant reduction in

BMI (-0.5 and 0.3 kg/m2), FPG (-0.8 and 0.4 mmol/L), HbA1c (-0.1 and 0.3%), MDA (-10.8

and 1.3 µmol/L) and Increase in GSH (0.8 and -0.8 µmol/gmHb) (p<0.001). Significant

reduction in PPPG (-1.1 and 0.3 mmol/L, p<0.03) and improvement in vitamin C (7.9 and -

6.2 µmol/L, p<0.002) was observed in yoga group.

1 Department of Medicine, Kasturba Medical College and Hospital, Manipal University

2 Department of Biochemistry, Srinivas Institute of Medical Science and Research Centre,

Mangalore, Karnataka, India

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There was significant improvement in number of proportion of people who tested positive for

CRP in the yoga group as compared to control. There was no difference in waist

circumference, WHR, BP, vitamin E and SOD in yoga group at follow up.

Our study is limited by the fact that the allocation to the groups was not randomized.

Random allocation in community settings is difficult. In this study, social and environmental

factors during these training sessions may have a beneficial influence on oxidative stress.

The strength of our study was the stratification of sample according to complications.

Participants with various complications may have increased oxidative stress; stratification

made the two groups identical.

In conclusion, yoga can be used as an effective therapy in reducing oxidative stress in type 2

diabetes. Yoga is also beneficial in improving glycaemic parameters and BMI and can be

administered as an add-on therapy to standard lifestyle interventions.

Yoga was not beneficial in reducing the blood pressure or waist circumference in this short-

term study. Further studies are needed to confirm that yoga is beneficial in preventing the

progression of diabetes and its complications.

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EFFECT OF YOGA THERAPY ON REACTION TIME, BIOCHEMICAL

PARAMETERS AND WELLNESS SCORE OF PERI AND POST

MENOPAUSAL DIABETIC PATIENTS

Dr MADANMOHAN1, Dr ISHWAR V BASAVARADDI

2, Dr ANANDA BALAYOGI

BHAVANANI 3, Dr ZEENA SANJAY

4, G DAYANIDY

5

INTRODUCTION:

The role of yoga in promoting health and preventing and managing psychosomatic

disorders has been established by numerous scientific studies. Yogic techniques

produce consistent physiological changes and have sound scientific basis. Yogic

lifestyle modification produces remarkable improvements and can make an

appreciable contribution to primary prevention as well as management of lifestyle

diseases. Yogic practices may aid in the prevention and management of diabetes

mellitus (DM) and reduce cardiovascular complications in the population. Reduced

ovarian function after menopause results in adverse changes in glucose and insulin

metabolism with derangement of lipoprotein profile that is associated with increased

risk of cardiovascular disease. The present study was undertaken to evaluate the effect

of yoga therapy on reaction time, biochemical parameters and wellness score of peri

and post menopausal diabetic patients.

MATERIALS AND METHODS:

15 peri and post menopausal patients receiving standard medical treatment for type 2

DM were recruited and reaction time and biochemical investigations were done before

and after a comprehensive yoga therapy programme comprising of three times a week

sessions for 6 weeks.

1 Professor and Head, Department of Physiology and Programme Director, ACYTER,

JIPMER, Puducherry-605006. 2 Director, Morarji Desai National Institute of Yoga, New Delhi

3 Programme Co-ordinator, ACYTER, JIPMER, Puducherry-605006.

4 Senior Research Fellow, JIPMER, Puducherry-605006.

5 Yoga Instructor, ACYTER, JIPMER, Puducherry-605006.

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A post intervention, retrospective wellness questionnaire compiled by ACYTER was

used to evaluate the comparative feelings of the patients after the therapy programme.

RESULTS:

Yoga training reduced auditory reaction time (ART) from right as well as left hand,

the decrease being statistically significant (p < 0.05) for ART from the right hand.

There was a significant (p < 0.01) decrease in fasting and postprandial blood glucose

levels as well as low density lipoprotein. The decrease in total cholesterol,

triglycerides, and very low density lipoprotein and increase in high density lipoprotein

was also statistically significant (p< 0.05). All the lipid ratios showed desirable

improvement with a decrease (p<0.01) of TC/HDL and LDL/HDL ratios and increase

(p<0.05) in the HDL/LDL ratio.

DISCUSSION:

Shortening of RT implies an improvement in the information processing and reflexes

and is the first such report in diabetic patients. This has clinical significance and is

worth further exploration with wider, well controlled, randomized studies in the

diabetic population. Changes in blood glucose levels may be due to improved insulin

sensitivity, decline in insulin resistance and increased sensitivity of the pancreatic

cells to glucose signals. Yoga improved the ‘heart friendly’ status of lipid profile in

our subjects and as our participants were peri and post menopausal, the decrease in

cardiovascular risk profile is of greater significance as loss of ovarian function results

in adverse changes in glucose and insulin metabolism with derangement of lipid

profile associated with increased risk of cardiovascular disease. The main strength of

our study is the excellent compliance and regularity of the yoga practice by the

patients both during the directly supervised sessions (99.63% attendance) and at

home, where all except one patient practiced regularly for an average of 4 days/week

and 30-40 min per day. Hence the all-round benefits obtained can be attributed to their

dedicated and regular practice. It is concluded that a comprehensive yoga therapy

programme has the potential to enhance the beneficial effects of standard medical

management of diabetes mellitus and can be used as an effective complementary or

integrative therapy programme.

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TEACHING YOGA TO SENIOR CITIZENS

Yogachemmal MEENA RAMANATHAN MSc (Yoga)

1

I have been fortunate and privileged to have opportunities to conduct yoga classes for senior

citizens through Pondicherry University Community College and ACYTER, JIPMER.

Teaching various yogic techniques to them has always been an unique experience. I have

always respected as well as wondered at their sense of commitment, dedication and

enthusiasm in learning this grand art/science. Their determination and sense of timing has

often left me speechless and flabbergasted.

As one grows older, the transformation back into the childhood begins. They are sometimes

self-centered and childish, craving to gain attention. They love to be praised and pampered

(who doesn’t for that matter?). Feeling sad, worried or bored may be more common for older

people who are facing retirement or coping with the death of a spouse, relative or friend.

Adapting to these changes leaves them feeling lonely. They carry a notion that they are of no

use anymore to the family or the society and hence start feeling inferior and depressed. Their

mobility, range of movement, flexibility and the ability to turn (I used to call it turnability- a

standard joke in the senior citizen class) is less than before. The physical stiffness radiates to

their mind too. Hence, before starting the practice sessions for them, it is essential to talk to

them on a personal basis and counseling is the first and foremost step before starting the

yogic curriculum. We need to understand their health conditions thoroughly before deciding

on the practices that could be given so that they gain the maximum benefit.

Yoga is commonly understood as a practice that is physically beneficial, whereas it is

concerned and related more with the mind than the body. Any sign of disease manifested in

the body is a result of a mental imbalance or an unhealthy attitude. Promoting healthy

lifestyles of elderly people is vital in helping them maintain good health and lead happy and

independent lives. In general, our life-span has increased and we live longer than we used to.

But as we grow older, we typically become more susceptible to ailments that are linked to

Co-ordinator Yoga Centre at MGMC & RI and Outreach Programmes of Yoganjali Natyalayam,

Puducherry.

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aging and as a result, we tend to move less. The less we move, the more susceptible we

become to a variety of ailments, and so it becomes a truly vicious cycle. Yoga has been

proven to help alleviate or reduce many of these health challenges, making it an increasingly

popular choice for the adult population. The many benefits of yoga may slow down or

even reverse the aging process.

According to Maharishi Patanjali, diseases are merely gross symptoms which accompany the

disturbances of mind called vikshepas, that appear as dukha (misery or pain), daurmanasya

(dejection), angamejayatva (tremors), and shvasaprashvasa, (disturbances in breathing).

Through yoga one can control these disturbances before they become powerful enough to

cause breakdown. Bhagavad Gita defines yoga as equanimity at all levels which may also be

taken as the perfect state of health where there is physical homeostasis and mental

equanimity giving rise to a healthy harmony between the body and mind. Hatha Yoga

Pradipika, states that “yoga improves the health of all alike and wards off diseases of one

who tirelessly practices yoga whether they are young, old, decrepit, diseased or weak,

provided they stick to the rules and regulations properly”. Swami Gitananda Giri Guru

Maharaj states, "yoga is the science and art of right-useness of body, emotions and mind".

Ammaji, Yogacharini Kalaimamani Meenakshi Devi Bhavanani, says that the regular,

repeated, rhythmic practice of yoga helps ward off mental fatigue, thereby ensuing better

physiological functioning.

PRACTICAL ASPECTS TAUGHT TO THE SENIOR CITIZEN

The seniors need to be motivated, encouraged and praised for their efforts and improvement

in the postures. Creating a supportive environment will make them practice regularly for both

the health benefits and the psychological perks. Any form of group activity is mood-elevating

for them. They enjoy the yoga sessions immensely and are more comfortable in their group,

which they have got so beautifully adapted to. The contact group, the cooperative and closely

knit relationship amongst them, provides a sense of belonging driving their loneliness away.

Yogic practices improve various motor skills. The jathis and kriyas improve flexibility.

Asanas are non-strenuous, non-fatiguing and can be performed comfortably even during old

age. Many times, they may not be able to achieve the final posture, but that hardly matters.

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Their effort in trying to achieve the pose, by itself, helps them gain the benefit. Otherwise

some variations of the pose which may be easier and less strenuous may be performed. Have

to be aware of the ability level of each participant, due to which, there may be a necessity, to

reduce the length of time for which an asana is held. Older participants may not have the

strength required to hold the pose for a longer period of time but gradually they gain strength

from practicing regularly. The pose can be repeated, if desired.

Never make them perform complicated poses, but always include at least one pose that is a

bit more challenging, which boosts up their confidence levels to a great extent.

As we age, we stop breathing fully. Controlled breathing in pranayama reminds us that it is

important to exhale as fully as we inhale. Focusing on deeper and slower inhalations and

exhalations slows down physiological functions. Yoga practices open energy channels,

harmonize functions of the body-mind and increase awareness. Brahmamudra in which body

movement, breath and sound vibrations are synchronized, induces a sense of relaxation and

reinvigorates head and neck regions. Seniors always enjoy pranayama practice wherein

exhalations are accompanied with the sound (nada). They feel their frustrations and

irritations evaporate with such practices.

Yogic relaxation techniques like spanda-nishpanda, kayakriya and marmanasthanam kriya in

shavasana help rejuvenate the body-mind complex and create a sense of awareness and

relaxation. Directing attention to different parts of the body channelizes energy to those parts.

BENEFITS OF YOGA SESSIONS

1. All participants express improvements in mood, emotional stability and attitude.

2. Elderly persons are often plagued with difficulty in falling asleep and staying asleep.

Yoga improves quantity and quality of sleep.

3. Other main benefit is a decrease in their blood sugar levels and normalization of their

blood pressure.

4. Their sense of adaptability and adjusting ability improves tremendously helping them

gel easily into the groove and into their group.

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5. Seniors who needed escorts to take them around are able to move around freely,

independently increasing their confidence and self-esteem. This makes them feel very

good after all these years.

6. They have a lot of pent-up emotions, which they have repressed over a period of time.

They are now able to overcome these because of the practices, giving them a sense of

happiness and well-being.

Old age can be made not only bearable but also pleasurable. After all, old age is not a matter

of years, but a condition of mind and yoga brings a healthy state of mind. Yoga aims at

enabling the individual to attain and maintain the “sukha-sthanam”, which enables one to

achieve a sense of physical, mental and spiritual wellbeing. Yoga not only adds a few years

to life but also adds life to those years. Therefore, practice of yoga, which is tremendously

beneficial to seniors, should become an integral part of old age.

CONCLUSION:

It is true that authentic research is essential for yoga to be accepted by the masses. However,

there are certain aspects which are beyond mere recordings, data collection and objective

evidence. The mutual experiences of a group of practitioners in a class - be it young energetic

students, senior citizens or special children - cannot be recorded by any instrument or

apparatus. Strong interpersonal bonding and mutual confidence and silent communications

enjoyed are something that has to be experienced and no explanation or data can explain that.

The interactivity is soulful. It is poetic. No references to quote and no literary evidences to

mention. Is anything more needed to achieve a sense of well being when there is a complete

integration of the body (physical practices), mind /emotions (pranayama and relaxation) and

soul (personal interactivity)? Isn’t this the state of bliss we wish and aim to accomplish?

What more proof is needed to substantiate and verify the benefits of this traditional, ancient

practice called yoga, passed on to us all the way down through the generations?

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STATISTICAL METHODS FOR MEDICAL/ YOGA RESEARCH

Dr. H.K.LAKSHMAN RAO PhD 1

It was indeed a pleasure to attend the workshop at JIPMER and interact with participants on the

vital role and importance of statistical methods in yoga research. The workshop was a great

event and the presentations were very useful, educative and an eye opener. Statistical methods

help measure and understand situations accurately and quantitatively. Statistical methods seek

to collect and collate meaningful and representative data, analyze adopting methods to get facts

from figures using correlation, regression techniques and to validate the hypothesis by adopting

tests such as t, Chi square, ANOVA, randomized blocks and Latin squares. It also helps in

making appropriate estimation of the variables, measuring cause and effects, trends, projections

at given levels of significance/ confidence.

Statistical methods are necessary and vital part of any scientific investigation. With computer

software support, any volume of data can be easily analyzed with some statistical knowledge

and interpretation skills. Research findings can then be meaningfully presented for future

verification of replicated data. For a fast growing science, statistical tools and techniques are

vital for generalization and universals applications.

There has been a common tendency among researchers to simply extrapolate observations from

small samples, not even based on probability /randomization to the entire population. What

appears to be significant/not significant at the sample level may not be so at the universal level.

Also analysis and results are based mostly on presentations and graphical indications.

Researchers are often saddled with several programs and issues regarding statistical methods

and they seldom seek clarifications from statisticians but choose go ahead with high degree of

compromise /risks in research methodology.

Following are some of the questions / doubts raised by researchers:

1. What should be the ideal sample size?

2. How to take samples when population exhibits heterogeneity?

3. When exactly statisticians have to be consulted? Management, Corporate & Statistical Consultant & Six Sigma Faculty (GOI),IIMA-CIIE-Mentor

email: [email protected] M-09381036989

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mailto:[email protected]


4. How to measure the normality of the distribution?

5. What is the significance of standard error and degree of freedom?

6. What are Type- I and Type II errors? How and when to minimize them.

7. How to control sampling and non- sampling errors?

8. What are point and interval estimates?

9. Under what conditions t, F, Z and Chi- square tests have to be adopted?

10. When are non- parametric tests ideal in research?

11. How normal distribution can be used for estimating the population parameters?

12. How to measure risks and their extent?

13. How to present a medical report statistically?

14. What is a probability sampling? Will it enhance the accuracy?

15. When and why to segment the population?

16. How to choose the level of confidence?

17. How to read statistical tables for interpretations?

18. What is six- sigma and how is it useful in medical administration?

19. How to use built-in software packages?

Any research study/ project carried out without confining to statistical process of data collection

and analysis/ interpretation ceases to be scientific. Research must not be undertaken based on

sample less than minimum number and with loosely stated hypothesis. It is vital to understand

the above basics of statistical methods and or techniques to confidently carry out research in

medical system and yoga systems.

The science of statistics is based on samples to measure such as averages, variations and

comparisons. Statistical sampling is different from the sample that we usually understand and

adopt. Statistical methods need to be adopted in full and not in parts to seek the truth / reality

about the population. We have to proceed from the known (sample) to the unknown (population/

Universe). We must proceed in a careful and methodical manner otherwise we will be misled to

illusions and wrong conclusions. The purpose of statistical methods is to minimize errors in our

judgment/ generalizations so that the research findings can be adopted with confidence.

Appropriate research methodology is therefore needed in order to spread the message of yoga for

wellness and such methodical approaches are essential.

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RESULTS OF A SURVEY OF PARTICIPANT FEEDBACK

AT ACYTER

Dr MADANMOHAN1, Dr ANANDA BALAYOGI BHAVANANI

2, Dr ZEENA

SANJAY3, G DAYANIDY

4 , L VITHIYALAKSHMI

5 , E JAYASETTIASEELON

6

The Advanced Centre for Yoga Therapy Education and Research (ACYTER), a collaborative

venture between JIPMER, Puducherry and Morarji Desai National Institute of Yoga

(MDNIY), New Delhi was established by MOU between JIPMER and MDNIY on 7 June

2008.

This advanced centre is focusing primarily on the role of Yoga in the prevention and

management of cardiovascular disorders and diabetes mellitus. Dr Madanmohan, Professor

and Head, Department of Physiology, JIPMER is the Programme Director.

Yoga therapy OPD is functioning in Super Specialty Block of JIPMER. Yoga therapy and

lifestyle consultation is given daily by Dr Ananda Balayogi Bhavanani, Programme

coordinator and Dr Zeena Sanjay, SRF while group and individual Yoga therapy sessions for

diabetes, cardiovascular diseases and other conditions are being conducted every day by the

Yoga instructors Sri G Dayanidy and Selvi L Vithiyalakshmi in the ACYTER Yoga Hall

situated in 3rd floor of Institute Block.

In the period from March to June 2011, a survey was done on 100 patients who were

regularly attending Yoga therapy sessions at ACYTER and had completed a minimum of one

month of the regular programme.

A questionnaire was given to them consisting of questions related to their age, gender and

demographic characteristic in addition to their main health complaints, attendance at the

1 Professor and Head, Department of Physiology and Programme Director, ACYTER,

JIPMER, Puducherry-605006 2 Programme Co-ordinator, ACYTER, JIPMER, Puducherry-605006

3 Senior Research Fellow, JIPMER, Puducherry-605006

4 Yoga Instructor, ACYTER, JIPMER, Puducherry-605006

5Yoga Instructor, ACYTER, JIPMER, Puducherry-605006

6 Senior Research Fellow, JIPMER, Puducherry-605006

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Yoga sessions, home practice as well as their physical and mental condition and changes in

dosage of medication.

Results of the survey are given in number of participants except for those questions where all

100 participants had not replied, in which case % values are reported instead.

AGE: Age of the participants ranged from 16 to 77 years with an average age of

47.04 ± 4.85 years (SEM). The maximum participants (39) were in the age group of

40-60 y while 25 were above 60 and 24 in the age group 30-40. There were 11 in the

age group 20-30 and 2 were below 20 y ears of age.

GENDER: 49 participants were male and 51 female.

DEMOGRAPHIC DATA: 91 of the participants were from Pondicherry town and

surrounding rural areas while 9 were from adjoining areas of Tamil Nadu.

MAIN HEALTH COMPLAINTS: The system wise break up of main health

complaints listed by the participants was: diabetes mellitus (41), hypertension and

other cardiovascular disorders (39), musculoskeletal disorders (13), respiratory

disorders (13), endocrine (12), neurological disorders (5), gastro intestinal disorders

(3), obstetrics and gynecological disorders (3), dermatological disorders (1)

psychiatric disorders (1) and others (11). Some of the participants had multiple

complaints.

REGULARITY OF ATTENDANCE AT ACYTER: 50 had attended yoga therapy

sessions for 1-3 months, 26 for 3-6 months, 16 for 6-12 months and 8 for more than a

year. 60 participants were attending the sessions 3 days/week, 21 of them 4

days/week while 8 were attending once/week, 7 twice /week, 2 five days/week and 2

six days/week. The regularity was attributed to a feeling of physical and mental

betterment (58%), regularity of the sessions (23%) and symptomatic relief (12%).

Inability to be more regular was attributed by the participants to work pressure and

examinations (7%).

REGULARITY OF HOME PRACTICE: 21 were practising at home on 3 days/week,

18 on 2 days, 11 on 5 days, 10 on all 7 days, 10 on 4 days, 9 on 6 days and 3 were

practising at home only once/week. 14 reported that they were not practicing at home

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at all. The regularity of home practice was attributed by the participants to a feeling of

physical and mental betterment (49%) while inability to be more regular was

attributed to lack of time (18%), work and education (18 %), laziness (9%) and other

home circumstances (6%). 46% of the participants reported a home practice of 30

min, 17% for 40 min, 16% for 20 min, 15% for 60 min and 6% reported that they

practised for more than an hour at home. This regularity was attributed to a feeling of

wellbeing (47%) while the irregularity was attributed to lack of time (29%), work

pressure (18%) and other factors (6%).

HEALTH STATUS: 56 participants reported that their health status was better than

when they started the yoga practice. 36 reported that it was much better than before

while 7 said that it was the same as before. One participant reported total relief from

his health complaints after starting the yoga programme.

DOSAGE OF MEDICATION: 56 participants reported no change in their

medication, 29 reported a decrease while 2 reported an increase in the dosage of their

medication. 13 of the participants were not on any medication.

GENERAL SUGGESTIONS: The majority of participants reported satisfaction with

the programme as well as the teaching methods of the instructors. General

suggestions included the need for more space for practice sessions, an increase in the

number of sessions as well as duration of sessions and possibility of sessions being

conducted after office hours. The participants thanked the Director JIPMER and

MDNIY for starting ACYTER thus enabling so many persons to benefit from the

excellent yoga programmes conducted free of cost.

POST INTERVENTION, RETROSPECTIVE WELLNESS QUESTIONNAIRE

A post intervention, retrospective wellness questionnaire compiled by ACYTER was used to

evaluate the comparative feelings of the patients after the therapy programme.

Five different responses ranging from ‘worse than before’ to “complete relief / total

satisfaction’ were utilized to evaluate various physical and psychological aspects of the

patient’s condition.

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Table 1: Responses of the participants to the retrospective wellness questionnaire

Worse than

before

Same as

before

Better

than

before

Much

better than

before

Complete relief /

Totally satisfied

Ability to concentrate - 12% 56% 30% 2%

Control of anger / loss

of temper - 15% 51% 26% 8%

Appetite 1% 26% 37% 24% 12%

Confidence level 2% 12% 41% 37% 8%

Ease of breathing - 14% 33% 41% 12%

Energy levels - 18% 39% 39% 4%

Enjoyment of life - 18% 41% 28% 13%

Feeling calm & fresh - 14% 32% 40% 14%

Feeling of hopelessness 1% 19% 36% 30% 14%

Feeling of loneliness 1% 15% 40% 30% 14%

General flexibility - 11% 37% 42% 10%

General mood - 7% 38% 47% 8%

General sense of

relaxation - 12% 37% 43% 8%

General wellbeing - 10% 36% 39% 15%

Joint mobility - 12% 36% 41% 11%

Nervousness - 14% 45% 34% 7%

Normality of menstrual

cycles 4 29% 21% 25% 21%

Pain levels - 14 41% 30% 15%

Performance of day-to-

day activities - 12% 41% 38% 9%

Sleep quality / duration 1 19% 26% 39% 15%

Stress levels - 17% 38% 33% 12%

Total wellbeing score 0.48% 15.24% 38.19% 35.05% 11.05%

108


The questionnaire was finalized in consultation with a 12 member team consisting of 3

eminent medical practitioners, 2 psychologists, 2 yoga experts, 2 eminent yoga therapy

consultants, 2 educationalists and one legal anthropologist.

The post intervention overall wellness scores of the participants are given below in Fig.1 and

the detailed breakup of % responses to each question is given above in Table.1.

Results of the retrospective wellness scores indicates that 11% attained complete relief from

their condition while 35% felt much better than before. 38 % were better than before while

15% had no change in their condition. The condition of 1% was worse than before.

Fig 1: Post intervention total well being score of participants

Worse than before 1%

Same as before

15%

Better than before

38%

Much better than

before35%

Complete relief 11%

109

;ksx fpfdRlk f’k{kk ,oa vuqla/kku mUUkr dsUnz

ADVANCED CENTRE FOR YOGA THERAPY,

EDUCATION & RESEARCH (ACYTER), JIPMER

(A collaborative venture between JIPMER, Puducherry, & MDNIY, New Delhi)

INTRODUCTION TO ACYTER

The Advanced Centre for Yoga Therapy Education and Research (ACYTER), a collaborative

venture between JIPMER, Puducherry and Morarji Desai National Institute of Yoga

(MDNIY), New Delhi was established by MOU between JIPMER and MDNIY on 7 June

2008. This advanced centre will focus primarily on the role of yoga in the prevention and

management of cardiovascular disorders and diabetes mellitus. Dr Madanmohan, Professor

and Head, Department of Physiology, JIPMER is the Programme Director.

AIMS & OBJECTIVES

To bridge the gap between yoga and modern medicine

To introduce yoga in medical curriculum and facilitate an awareness of the therapeutic

potential of yoga amongst the medical professionals

To provide quality yoga and lifestyle consultation and standardized yoga therapy to

patients of JIPMER

To conduct collaborative research projects with MDNIY

To conduct seminars, workshops, symposia and conferences

To standardize yoga techniques and procedures

To conduct yoga classes for JIPMER staff, students and general public

To create an awareness about the art and science of yoga amongst the people of

Pondicherry and surrounding regions

SERVICES OFFERED THROUGH ACYTER

Yoga therapy OPD is functioning in Super Specialty Block of JIPMER. Yoga therapy and

lifestyle consultation is given by Dr Ananda Balayogi Bhavanani, Programme co-ordinator

and Dr Zeena Sanjay, SRF from 9.30 AM to 1 PM every day.

Group and individual Yoga therapy sessions for diabetes, cardiovascular diseases and other

conditions are being conducted every day from 10 AM to 1 PM and 3 to 4.30 PM in the

ACYTER Yoga Hall situated in 3rd

floor of institute block.

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A senior citizen clinic is being conducted every Thursday from 11 AM to 12 noon and Mrs.

Meena Ramanathan, Guest faculty is conducting the special sessions that have been well

appreciated by the senior citizens of Pondicherry.

Regular yoga classes are being conducted from 6.30 to 7.30 AM and 4.30 to 5.30 PM on

Monday, Wednesday and Friday at the ACYTER Yoga Hall situated in 3rd

floor of institute

block. The Yoga Institutors, Sri G Dayanidy and Selvi L Vithiyalakshmi are conducting the

classes for JIPMER staff, students and their family members on a regular basis.

ACYTER Yoga Research Lab is functioning in SS Block since 6 July 2011 and regular studies

are being done on patients of diabetes, hypertension and heart failure along with the

administration of questionnaires. Various pilot studies on patients as well as normal volunteers

are being conducted by Sri E Jayasettiaseelon, SRF in coordination with Sri Harikrishna PhD

Scholar and Dr Rajajeyakumar, SR, Department of Physiology.

ACTIVITIES OF ACYTER

ACYTER has been active in conducting Yoga training for medical students, organizing a mass

awareness programme in 48 schools of Puducherry and organized a National Workshop on

“Introducing Yoga in Medical Curriculum” in March 2009. Regular academic programmes are

being held every Saturday and three foreign delegations from Australia and New Zealand,

Belgium and Germany have visited ACYTER and participated in the activities during 2009.

Yoga awareness programmes have been conducted for staff and students of the Government

Dental College and for participants of the Nursing Workshops on AIDS at the JIPMER

Nursing College. ACYTER also conducted yoga and healthy lifestyle consultations for the

delegates attending the Regional Official Language Conference for South and South Western

Zone at JIPMER in October 2009 and the 17 International Yoga Festival conducted by

Department of Tourism, Government of Pondicherry in January 2010.

ACYTER organized a workshop on Chakra Meditation for Healing by Sri Balaratnam, founder

Vibrational Breath Therapy Melbourne, Australia on 1 January 2010. Dr Madanmohan,

Programme Director, Dr Ananda Balayogi Bhavanani, Programme Co-ordinator and staff

members ACYTER participated actively in the 17 International Yoga Festival conducted by

Tourism Department, Government of Puducherry at Sri Subulakshmi Mahal from 4-7 January,

2010.

ACYTER also participated in the Workshop on “Stress Management and Personality

Development though Yoga” conducted by Anandita Trust, New Delhi in January 2010 at

Pondicherry. ACYTER conducted a Workshop-cum-Seminar on Yoga and Complementary

Therapies for HIV/AIDS in collaboration with Pondicherry AIDS Control Society (PACS) on

30 January, 2010.

Programme Director and, Programme Co-ordinator were invited speakers for the National

Yoga Week 2010 organized by MDNIY at New Delhi from February 12 to 18. Programme

Director chaired a session on “Yoga for Cardiovascular Health” while Programme Co-

ordinator conducted a workshop on “Yoga for Technostress” in collaboration with staff of

MDNIY. Shri E Jayasettiaseelon, SRF and Shri G Dayanidy, yoga instructor participated in

the conference, seminar and workshop organized during the week long programme at MDNIY.

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Programme Co-ordinator presented an invited talk on “Yoga: A boon for maternal and child

health” at Mother Theresa Institute for Health Science as part of the State Level Champaign

for mother and child health organized by the Directorate of Indian Systems of Medicine and

Homeopathy, Government of Pondicherry on 23 February 2010. All the participants and

eminent experts of modern medicine and alternative medicine who were present on the

occasion appreciated the presentation that highlighted the importance of yoga in both antenatal

and postal natal care.

Special classes on yoga for antenatal and postnatal health were conducted on 23 and 24

February for students of final year B.Sc Nursing at the JIPMER Nursing College. The classes

were conducted by Selvi Vithiyalakshmi, yoga instructor while Programme Co-ordinator gave

a theory session highlighting important yoga practices for both antenatal and postal natal care.

More than 50 students participated in the classes enthusiastically.

Programme Co-ordinator presented invited talks on “Bridging yoga and modern medicine” and

“Yoga research-where are we?” during the Seminar on Yoga for Doctors organized and

conducted at Kaivalyadhama, Lonavla, Maharashtra on 26 and 27 February 2010.

ACYTER and Department of Physiology, JIPMER organized a two day National Workshop-

cum-Seminar on “Role of Yoga in Prevention and Management of Hypertension” on 18 and

19 March 2010 at JIPMER. The workshop was organized in collaboration with Morarji Desai

National Institute of Yoga (MDNIY), New Delhi, an autonomous organization under the

Department of AYUSH, Ministry of Health and Family Welfare, Govt. of India. The workshop

was inaugurated by Dr KSVK Subba Rao, Director JIPMER and Dr AK Das, Medical

Superintendent, JIPMER was guest of honour. Senior faculty members from various

departments of JIPMER as well as eminent yoga and medical experts from all over the country

participated in the inaugural function.

The workshop deliberated on the role of yoga in the prevention and management of

hypertension with keynote lectures, invited talks, lecture-demonstrations, panel discussions

and practice sessions that were given by a team of 27 resource persons from JIPMER, DIPAS,

Krishnamacharya Yoga Mandiram, Iyengar Yogashraya, Sikkim, Kaivalyadhama and the

International Centre for Yoga Education and Research (ICYER). Nearly 200 participants

including medical, paramedical & yoga professionals from all over the country attended the

workshop along with 100 first year medical students of JIPMER.

One month Foundation Course in yoga for Medical and Paramedical Professionals and

Students was conducted at JIPMER from 18 October to 20 November 2010. 63 medical

doctors, paramedical professionals, students and staff members of JIPMER participated in the

training programme. The theory lectures were conducted in Bernard Theatre and practice

sessions in the auditorium of the Nursing College under the direction of Dr. Madanmohan,

Professor and Head, Department of Physiology, JIPMER and Programme Director ACYTER.

Dr Ananda Balayogi, Programme Coordinator ACYTER was invited to present a lecture on

“Yoga for women” in the 8th

National Conference hosted by Puducherry Chapter of Society of

Midwives on 13 November 2010. He was invited to present another lecture on “Principles &

Practice of Yoga Therapy for Geriatric Psychiatric Disorders" in the one day workshop on

"Yoga Therapy for Psychiatric Disorders" held at the Advanced Centre for Yoga, NIMHANS,

Bangalore on 5 December 2010. The event was organized jointly by the Advanced Centre and

Morarji Desai National Institute of Yoga, New Delhi.

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A delegation of yoga teachers from Italy visited ACYTER on 11th

December and expressed

their admiration for the programme and its activities. They were especially appreciative that

Indian Government was bringing Yoga into the mainstream health care system through

advanced centers at JIPMER, NIMHANS, DIPAS, Gujarat Ayurveda University & at

Government Medical College, Jammu.

Staff of ACYTER also participated in the 18th

International Yoga Festival Conducted by the

Government of Pondicherry from 4-7 January 2011. Invited talks were given by Dr Ananda

Balayogi, Programme Coordinator ACYTER and free consultation on yoga and healthy living

was provided to 102 delegates and members of the public in the ACYTER stall. Sri G

Dayanidy, Yoga Instructor ACYTER won first place in the 25-35 age category and was

selected to participate in the Final Championship Round.

Staff of ACYTER presented talks and lecture demonstrations during the CME on

Physiological Effects of Yoga, organized by Department of Physiology, Sri Satya Sai Medical

College and Research Institute, near Chennai on January 17, 2011. Dr Madanmohan,

Programme Director presented an overview of “Yoga and Physiology” while Dr Ananda

Balayogi, Programme Coordinator gave a talk on “Therapeutic Potential of Yoga”. Dr Zeena

Sanjay gave a talk on “Yoga research” that also highlighted the activities of ACYTER, while

Sri G Dayanidy gave a spectacular demonstration of various Yoga Asanas with commentary

by Dr Ananda. The CME was attended by more than a hundred members of the management,

faculty, staff and students who gave positive feedback and expressed appreciation for the

entire programme.

Dr Madanmohan, Programme Director and Dr Ananda Balayogi, Programme Coordinator

were invited to give invited talks and workshops during the Golden Jubilee National Seminar

cum Workshop cum on “Role of Yoga in Respiratory Tract Disorders” on January 20-21,

2011. The event was organized by Advanced Centre for Yoga Education and Research,

Gujarat Ayurved University, Jamnagar and MDNIY.

Dr Madanmohan, Programme Director and Dr Ananda Balayogi, Programme Coordinator and

Dr Zeena Sanjay attended National Yoga Week 2011 conducted at MDNIY. Dr Madanmohan

chaired an academic session and addressed the valedictory function while Dr Ananda gave an

invited talk on “Yoga for general well being”.

ACYTER conducted National workshop – cum seminar on Role of yoga in prevention &

management of diabetes mellitus, organized at JIPMER on March 1&2, 2011. Proceedings of

the “National workshop cum seminar on role of yoga in prevention and management of

hypertension” and Tamil booklets on “Yogic Management of Diabetes Mellitus”, “Yogic

Management of Cardiovascular Disorders” and “Normal healthy diet” were released.

ACYTER is conducting specialized yoga therapy sessions for pregnant ladies on Tuesdays /

Thursdays at ACYTER as part of a pre–eclampsia prevention clinical trial being conducted in

collaboration with the Department of Obstetrics and Gynecology with Dr K Manikandan, Asst

Professor as Principal Investigator. The trial has been registered as CTRI/2011/10/002064 with

Clinical Trials Registry- India (CTRI).

As part of the introduction of yoga to medical professionals, the Programme Director and staff

of ACYTER conducted pranayam classes for senior and junior residents and research scholars

of Physiology department. 20 participants attended the classes held in May and June 2011.

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The ACYTER Yoga Research Lab was inaugurated on July 6th

2011 by Dr. KSVK Subba Rao,

Director, JIPMER in the Super Specialty Block. Dr. AK Das, Medical Superintendent and Dr.

Balachander, Professor and Head, Dept. of Cardiology were special invitees. Patients are being

referred from the Yoga OPD and Shri E Jayasettiaseelon, SRF is monitoring pre and post

recordings of health parameters as part of various pilot projects and case studies. Patients are

given advice on lifestyle modification based on their anthropometry, biochemical and

psychological health profile parameters. Baseline HRV is being recorded for all patients

attending the Yoga OPD with special emphasis on diabetes and cardiovascular disorders.

Recordings have been completed for 171 patients till date.

Free Hypertension screening and Yoga consultation Programme was conducted in Lawspet,

Pondicherry on August 6th

2011. More than 150 members of the general public attended the

programme organized by the residents and PhD scholars of the Department of Physiology and

staff members of ACYTER in coordination with the local MLA.

The Programme Co-ordinator was invited Guest Speaker at CME on Obesity organized by

Woman Doctors Association (TN) at Sri Lakshminarayanan Institute of Medical Studies,

Pondicherry on August 7 2011 and presented interactive talk on “Dealing with obesity the

Yoga way”. Mr. G Dayanidy, Yoga Instructor gave an excellent yoga demonstration.

During August and September 2011 Sri G Dayanidy and Selvi L Vithiyalakshmi, Yoga

instructors of ACYTER gave yoga theory and practical sessions for 40 students of

physiotherapy at Mother Theresa Institute of Health Sciences, Pondicherry. This was

organized as part of the ACYTER yoga education programme for paramedical professionals

and students.

Dr Ananda Balayogi Bhavanani, Programme Coordinator ACYTER was invited to present a

lecture on “Yoga and Education” on December 21 during the 19th

International Yoga

conference at SVYASA, Bangalore.

Staff of ACYTER conducted a special Yoga Awareness programme for more than 50

corporate executives and invitees of the Harmoney Company at Hotel Athiti on January 21

2012.

Dr Madanmohan, Programme Director presented an Invited talk on “My work in yoga” on

February 4 at Golden Jubilee Celebrations of Kashmir Medicos Association and CME, New

Delhi. He also presented an Invited talk on February 10 on “Integrating naturopathy and yoga

in conventional medical education” and chaired a session in the International Conference on

Yoga, Naturopathy and AROGYA Expo – 2012, Bangalore.

Dr Madanmohan, Programme Director and Dr Ananda Balayogi Bhavanani, Programme

Coordinator presented Key Note addresses and chaired scientific sessions during National

Yoga Week from February 12-18 at MDNIY, New Delhi. Poster presentation of ACYTER

activities was exhibited by Sri E Jayasettiaseelon, SRF and Miss L Vithiyalakshmi.

RESEARCH WORKS

Many research projects are being conducted at JIPMER as collaborative efforts between

ACYTER and the Departments of Physiology, Medicine, Biochemistry, Cardiology and

Obstetrics & Gynecology. Papers and abstracts have been published and also submitted for

publication. Details of various studies completed / in progress are given below:

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PhD theses: (in progress):

1. Effect of yoga therapy on cardiac autonomic functions and oxidative stress in

prehypertensive subjects: a randomized controlled study.

2. Effect of yoga therapy on cardiac function, response to exercise, oxidative stress and

quality of life in heart failure patients: a randomized controlled trial.

MD dissertations:

Completed:

1. Effect of 12 week yoga therapy as a lifestyle intervention in patients of type 2 diabetes

mellitus with distal symmetric polyneuropathy – a randomized controlled study.

2. Effect of yoga therapy on cardiac autonomic function in patients of essential

hypertension – a randomized controlled study.

In Progress:

1. Effects of slow and fast pranayams on pulmonary function, handgrip strength and

endurance in young healthy volunteers – a randomized controlled trial.

2. Effect of yoga training on autonomic functions and reaction time in young healthy

females during different phases of menstrual cycle.

3. Effect of pranayam on maximal exercise performance, pulmonary function, recovery

heart rate and blood pressure in healthy adults.

MSc dissertations (completed):

1. Effect of yoga training on cardiorespiratory functions of normal young volunteers

2. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of

peri and post menopausal diabetic patients.

3. Effect of yoga training on heart rate, blood pressure and lipid profile of patients with

essential hypertension.

4. Effect of yogic training on physical and biochemical variables of type 2 diabetes

mellitus patients.

OTHER RESEARCH PROJECTS:

Completed: Patient feedback survey and retrospective wellness questionnaire was completed

for 100 patients in June 2011.

In progress:

1. Effect of slow and fast pranayams on cognitive and autonomic parameters in young

healthy subjects.

2. Effect of mid trimester yoga on the incidence of pre-eclampsia in high risk women.

PILOT STUDIES:

Completed:

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1. Immediate effect of sukha pranayama on heart rate and blood pressure of patients with

hypertension.

2. Immediate cardiovascular effects of kaya kriya in normal healthy volunteers.

3. Immediate effect of shavasana and savitri pranayama on heart rate and blood pressure

of hypertensive patients.

4. Immediate effect of chandra nadi pranayama on heart rate and blood pressure of

hypertensive patients.

5. Immediate cardiovascular effects of shavasana and pranava pranayama on heart rate

and blood pressure of hypertensive patients.

6. Immediate effects of yoga nidra on heart rate and blood pressure.

7. Immediate effect of suryanadi and chandranadi on short term heart rate variability in

healthy volunteers.

8. Immediate cardiovascular effects of pranava pranayama in hypertensive patients.

9. Immediate effect of yoga practices on blood pressure.

10. Immediate effect of suryanadi pranayam on heart rate and blood pressure of


In Progress:

1. Acute effect of anulom vilom pranayam on heart rate variability in healthy volunteers.

2. Immediate effect of 5 minutes chandranadi pranayam on heart rate variability in



Diabetes mellitus patients.

4. Acute effect of 5 minutes chandranadi pranayam on heart rate variability in patients

with diabetes mellitus and hypertension.


patients of heart failure.

6. Effect of respiratory rate on heart rate variability in healthy volunteers.

7. Effect of yoganidra on short term HRV in heart failure patients.

8. Acute biochemical and physiological effects of unilateral and bilateral nostril breathing

in patients of diabetes.

9. A controlled trial of immediate effects of pranava pranayama in shavasana on patients

having both diabetes and hypertension.

CASE STUDIES (completed):

1. Effect of yoga on subclinical hypothyroidism.

2. Effect of yoga in newly diagnosed hypertension.

3. Effect of yoga in a patient of long standing diabetes and hypertension.

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4. Case report on COAD in an adult.

5. Case report on bronchial asthma in a 4 year old child.

PUBLICATIONS

Published papers:

1. Effect of yoga therapy on reaction time, biochemical parameters and wellness score of

peri and post menopausal diabetic patients. Madanmohan, Ananda Balayogi

Bhavanani, Dayanidy G, Zeena Sanjay, Basavaraddi IV. International J Yoga 2012; 5:

10-15.

2. Immediate effect of sukha pranayama on cardiovascular variables in patients of

hypertension. Ananda Balayogi Bhavanani, Zeena Sanjay, Madanmohan. International

J Yoga Therapy 2011; 21: 4-7.

3. Don’t put yoga in a small box: the challenges of scientifically studying yoga. Ananda

Balayogi Bhavanani. International J of Yoga Therapy 2011; 21 ; 21.

4. A comparative study of slow and fast suryanamaskar on physiological functions.

Ananda Balayogi Bhavanani, Kaviraja Udupa, Madanmohan, Ravindra PN.

International J Yoga 2011; 4: 72-77.

5. Effect of yoga on subclinical hypothyroidism: a case report. Ananda Balayogi

Bhavanani, Zeena Sanjay, Madanmohan. Yoga Mimamsa 2011; 43: 102-107.

6. Yogic perspective on depression and mental health. Ananda Balayogi Bhavanani. Yoga

Mimamsa 2011; 43: 254-264.

7. Results of a survey of participant feedback at ACYTER, JIPMER Pondicherry.

Madanmohan, Ananda Balayogi Bhavanani, Zeena Sanjay, G Dayanidy, L

Vithiyalakshmi, E Jayasettiaseelon. Yoga Life 2011; 42 (Nov): 11-13.

8. Are we practicing yoga therapy or yogopathy? Ananda Balayogi Bhavanani. Yoga

Therapy Today 2011; 7 (2): 26-28

9. Introducing yoga to medical students: the JIPMER experience. Madanmohan. Yoga

Vijnana 2008; 2: 71- 78.

Published abstracts

1. Role of yoga in prevention and management of cardiovascular disease: the JIPMER

experience. (Published invited talk) Madanmohan. Souvenir & Abstract. 24th

Annual

Conference, Indian Society for Atherosclerosis Research & International CME on

Atherosclerosis 2011, p 7-10.

2. Immediate effect of suryanadi and chandranadi on short term heart rate variability in

healthy volunteers. Rajajeyakumar M, Madanmohan, Amudharaj D, Bandi

Harikrishna, Jeyasettiseloune, Bhavanani AB. Indian J Physiol Pharmacol 2011; 55 (5

supplement): 43-44.

3. Yoga and the educational process. Ananda Balayogi Bhavanani. Souvenir 19th

International Conference on Yoga. SVYASA, Bengaluru. December 2011. p 122.

117

Papers in press

1. Role of yoga in managing bronchitis. Ananda Balayogi Bhavanani and Zeena Sanjay

(Journal of Alternative and Complementary Medicine).

2. Immediate effect of chandra nadi pranayama (left unilateral forced nostril breathing) on

cardiovascular parameters in hypertensive patients. Ananda Balayogi Bhavanani,

Madanmohan, Zeena Sanjay (International Journal of Yoga).

3. Yoga is not an intervention, but maybe yogopathy is. AB Bhavanani (Int Jof Yoga).

4. Immediate cardiovascular effects of pranava pranayama in hypertensive patients.

Ananda Balayogi Bhavanani, Madanmohan, Zeena Sanjay, Basavaraddi IV (Indian

Journal of Physiology and Pharmacology).

5. Immediate effect of mukha bhastrika (a bellows type of pranayama) on reaction time in

special children. AB Bhavanani, Meena Ramanathan, Harichandrakumar KT (IJPP)

6. Effects of a comprehensive eight week yoga therapy programme on cardiovascular

health in patients of essential hypertension. Madanmohan, AB Bhavanani, Zeena

Sanjay, Vithiyalakshmi L, Dayanidy G (Indian Journal of Traditional Knowledge).

7. Immediate cardiovascular effects of pranava relaxation in patients of hypertension and

diabetes. Ananda Balayogi Bhavanani, Madanmohan, Zeena Sanjay, Vithiyalakshmi L

(National Medical Journal of India)

ATTENDANCE AT YOGA OPD AND PRACTICE SESSIONS

Yoga therapy OPD is functioning in the Super Specialty Block of JIPMER daily from 9 AM to

1 PM and yoga therapy sessions are being conducted at ACYTER yoga hall for diabetes

everyday from 10 – 11 AM, for cardiovascular diseases from 11 AM – 12 noon on Mondays,

Wednesdays and Fridays and from 12 noon – 1 PM everyday for other disorders. Sessions are

conducted individually and in groups as per requirements of the patients and directions of

therapists. Yoga classes for normal subjects are being conducted on Mondays, Wednesdays

and Fridays at 6.30 AM and 4.30 PM and for senior citizens on Thursdays between 11 AM and

12 noon.

2009

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Grand total

OPD attendance 92 116 95 112 183 97 91 786

Therapy sessions

Diabetes 77 150 176 137 166 141 72 919

Hypertension 35 100 116 79 105 77 43 555

Other disorders 70 77 117 134 157 151 97 803

Senior citizens 41 57 30 30 18 8 38 222

Normal subjects 16 29 23 9 14 16 50 157

Total 331 529 557 501 643 490 391 3442

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2010

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Grand total

OPD attendance 82 77 68 71 87 96 109 112 62 85 74 75 998

Therapy sessions

Diabetes 47 116 108 73 53 68 113 171 133 192 159 242 1475

Hypertension 29 49 57 43 34 52 75 101 117 110 82 128 877

Other disorders 58 162 142 133 155 148 204 150 135 213 162 216 1878

Senior citizens 17 38 35 29 17 19 42 35 39 36 32 44 383

Normal subjects 73 57 41 44 36 77 134 88 119 59 35 70 833

Total 306 499 451 393 382 460 677 657 605 695 544 775 6444

2011

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Grand

total

OPD attendance 214 74 148 81 118 110 104 190 113 111 150 93 1506

Therapy sessions

Diabetes 224 258 265 246 300 232 236 167 251 148 143 146 2616

Hypertension 120 118 186 186 176 151 133 199 182 134 146 158 1889

Other disorders 186 232 352 245 243 254 269 181 185 163 147 148 2605

Senior citizens 21 29 45 28 45 53 40 49 49 16 25 50 450

Normal subjects 146 150 119 98 142 92 140 105 392 541 425 192 2542

Total 911 861 1115 884 1024 892 922 891 1172 1113 1036 787 11608

;ksx fpfdRlk f’k{kk ,oa vuqla/kku mUUkr dsUnz

ADVANCED CENTRE FOR YOGA

THERAPY, EDUCATION & RESEARCH (ACYTER), JIPMER

(A collaborative venture between JIPMER, Puducherry, & MDNIY, New Delhi)

For more details please contact: 0413-2272380-9 (Extn: 6239).

Email: [email protected]

Website: www.jipmer.edu/ACYTER/main.html

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